恶性潜能未定的前列腺间质肿瘤的临床诊治分析

Clinical analysis of diagnosis and treatment of prostatic stromal tumors of uncertain malignant potential

目的探讨罕见的恶性潜能未定的前列腺间质肿瘤(stromal tumor of uncertain malignant potential,STUMP)的临床特点及诊治方法。方法回顾性分析2012年5月—2020年5月复旦大学附属中山医院收治的6例STUMP患者的诊治及行机器人辅助腹腔镜下前列腺根治性切除术(robot-assisted laparoscopic radical prostatectomy,RARP)术后随访结果并复习相关文献。结果本组患者发病年龄28~75岁,主要表现为逐渐加重的下尿路梗阻症状、尿潴留、肉眼血尿。血清前列腺特异性抗原正常或轻度升高。经直肠超声和核磁共振提示前列腺实质或囊实性肿瘤或前列腺增生。根据前列腺穿刺活检病理,4例提示STUMP或前列腺间质肿瘤的患者行RARP;2例提示前列腺增生的患者行经尿道前列腺电切(transurethral resection of the prostate,TURP),术后病理为STUMP,后因肿瘤复发行RARP。RARP术后患者平均随访75.17个月,术后3个月尿控率为100%,无ClavienⅡ级及以上并发症。5例无复发,1例术后因后尿道局部复发行经尿道肿瘤电切。结论STUMP临床表现与前列腺增生相似。经直肠超声、核磁共振有助于早期诊断。前列腺穿刺活检因标本有限常易诊断为“前列腺增生”,对影像学检查提示肿瘤可能和(或)有前列腺增生手术指征的患者,TURP既是诊断也是治疗方法之一。TURP术后易复发,RARP是安全有效的微创治疗方法。

Objective To explore the clinical characteristics,diagnosis and treatment of a rare prostatic stromal tumor of uncertain malignant potential(STUMP).Methods A retrospective analysis was made on diagnosis and treatment of six patients with STUMP admitted to our hospital from May 2012 to May 2020,and the follow-up results after robot-assisted radical prostatectomy(RARP),and relevant literature was reviewed.Results The age of patients was 28 to 75 years.The main symptoms were progressive aggravation of lower urinary tract obstruction,urinary retention and gross hematuria.Serum PSA was normal or slightly elevated.Transrectal ultrasound and magnetic resonance imaging(MRI)suggested a solid or solid cystic tumor of prostate or prostatic hyperplasia.According to prostate biopsy pathology,4 cases with STUMP or prostate stromal tumor underwent RARP.Two patients with prostate hyperplasia underwent transurethral resection of the prostate(TURP),and the postoperative pathology was STUMP.RARP was later performed due to tumor recurrence.Patients were followed up for an average of 75.17 months after RARP.The rate of postoperative urinary continence at 3 months was 100%,and none had Clavien gradeⅡor above complications.There was no recurrence in 5 patients,but one patient underwent transurethral resection of tumor due to local recurrence of posterior urethra.Conclusion The clinical manifestations of STUMP are similar to those of benign prostatic hyperplasia.Transrectal ultrasound and MRI are helpful for early diagnosis.It is often easily misdiagnosed as benign prostatic hyperplasia by prostate biopsy due to limited specimens.TURP is a diagnostic and therapeutic method for patients whose imaging examination indicates suspected tumor and/or have surgical indications for prostatic hyperplasia.Recurrence is common after TURP,so RARP is a safe and effective minimally invasive treatment.