前列腺小细胞神经内分泌癌临床病理特点分析

Clinicopathological characteristics of small cell neuroendocrine carcinoma of the prostate

目的探讨前列腺小细胞神经内分泌癌(SCNPC)的临床病理特点及预后特征。方法分析2015年至2022年徐州医科大学附属医院诊治的7例前列腺SCNPC(6例为初次诊治, 1例为肝转移性前列腺SCNPC)的临床及病理资料。免疫组织化学EnVision法标记嗜铬粒素A(CgA)、突触素(Syn)、雄激素受体(AR)、前列腺特异抗原(PSA)、细胞核增殖抗原(Ki-67)。采用t检验和χ^(2)检验。结果单纯SCNPC患者中3例血清PSA值正常(参考范围<4 ng/ml), 2例轻度升高(5.41、5.56 ng/ml), 而2例混合性SCNPC患者血清PSA值平均17.05 ng/ml(11、23.10 ng/ml)。4例患者血清前列腺特异抗原(PSA)>4 ng/ml, 平均11.3 ng/ml;其余3例患者PSA为正常范围。前列腺根治切除4例, 经尿道切除1例, 穿刺活检1例, TNM分期2例pT2, 1例pT3, 3例pT4, 另有肝脏转移病灶穿刺标本1例, 分期为M1c。4例根治性标本大体切面灰白色, 鱼肉状, 质地细腻。显微镜下肿瘤组织呈片状, 巢状分布, 伴片状凝固性坏死, 瘤细胞密度高, 体积较小, 胞质稀少, 核分裂象和凋亡易见, 形态学与肺小细胞癌相似。肿瘤累及被膜、双侧精囊腺、膀胱颈及前列腺尖端, 并见神经及脉管侵犯。免疫组织化学染色CgA(5/7例)、syn(7/7例)阳性表达;AR(6/7例), PSA(5/7例)阴性表达;Ki-67范围60%~90%, 平均70%。结论前列腺SCNPC是一种高度恶性肿瘤。患者血清PSA正常或轻度升高。AR缺失表达, 雄激素剥夺治疗(ADT)效果差。

Objective To investigate the clinicopathological and prognostic value of small cell neuroendocrine carcinoma of the prostate(SCNPC).Methods The clinicopathological data of 7 cases of SCNPC admitted to the Affiliated Hospital of Xuzhou Medical University between 2015 to 2022 were analyzed.Among these patients,6 cases were initially diagnosed and one case was also manifested with liver metastatic SCNPC.Chromogranin A(CgA),synaptophysin(Syn),androgen receptor(AR),prostate-specific antigen(PSA),proliferating cell nuclear antigen(Ki-67)were analyzed using immunohistochemical staining by EnVision method.T test andχ^(2) test were used.Results The level of serum PSA of the pure SCNPC was normal in 3 patients(<4 ng/ml)and slightly elevated in 2 patients(5.41 and 5.56 ng/ml respectively),but up to 17.05 ng/ml(11.00 and 23.10 ng/ml)in 2 patients with mixed SCNPC.The level of serum PSA was above 4 ng/ml in 4 patients,with an average of 11.3 ng/ml,and the rest patients had a normal PSA.In these patients,4 cases underwent radical prostatectomy,one case underwent transurethral resection,and one case underwent puncture biopsy.Two cases belonged to pT2,one case belonged to pT3,3 cases belonged to pT4,and one case was combined with liver metastasis,which belonged to M1c.The cut surface of the radical prostatectomy in 4 cases was gray and fish-like area.Microscopically,the tissue showed sheet and nested distribution with coagulated necrosis.The tumor cells were characterized by high density,small volume,sparse cytoplasm,high mitosis and apoptosis.The morphological feature was similar to small cell carcinoma of the lung.In these cases,the prostate capsule,bilateral seminal vesicles,bladder neck and apex were all involved,and nerve and vascular vessels were invaded.Immunohistochemical staining showed positive expression of CgA(5/7 cases)and SYN(7/7 cases);negative expression of AR(6/7 cases),PSA(5/7 cases).The positive expression rate of Ki-67 ranged from 60%to 90%,with an average of 70%.Conclusion SCNPC is a highly malignant tumor.Serum PSA was normal or slightly elevated.AR is absent,and androgen deprivation therapy is not effective.