前列腺肉瘤的MRI特征及临床表现:与前列腺癌的比较

Clinical and MRI features of prostate sarcoma: comparison with prostate adenocarcinoma

目的 总结前列腺肉瘤的MRI特征和临床表现 ,并与前列腺癌比较。方法 搜集经病理证实的 6例前列腺肉瘤 ,并选择同期 15例前列腺癌作对照 ,分析临床资料、实验室结果及影像表现 ,分析两者间差异的特征性。结果 (1)病理结果 :前列腺肉瘤中横纹肌肉瘤 3例 ,平滑肌肉瘤1例 ,间质来源无法分类的肉瘤 1例 ,间质来源未分类的肉瘤 1例 ;前列腺腺癌 15例。 (2 )临床结果 :前列腺肉瘤 :年龄中位数为 36 5 (范围为 15～ 71)岁 ;病史 1个月至 5年 ;症状主要为进行性排尿困难 ;肛门指诊前列腺显著增大 ,表面不光滑 ,有结节或有囊性感 ,有压痛 ;前列腺特异性抗原 (PSA)在正常范围 [(0 2 0～ 4 0 0 )× 10 3 ng/L],中位数为 0 5 6× 10 3 ng/L。前列腺癌 :年龄中位数为 72 (范围为 5 0～78)岁 ;病史 5个月到 17年 ;症状主要为尿急、尿频、排尿困难 ;肛门指诊前列腺呈轻、中度增大 ,表面光滑 ,质硬 ,无压痛 ;PSA值升高 ,中位数为 2 7 80× 10 3 ng/L ,范围为 (1 5 5～ 35 2 0 0 )× 10 3 ng/L。 2种疾病的发病年龄和血清PSA值比较差异均有显著性意义 (P <0 0 5 )。 (3)MRI表现 :前列腺肉瘤表现为前列腺体积明显增大 ,中位数为 2 17 4 6cm3 ,范围为 6 4 35～ 85 9 0 4cm3 ,占据盆腔的大部 ,呈分叶状 ;正常?

Objective To summarize the clinical and imaging features of prostate sarcoma, and to compare the features with those of prostate adenocarcinoma (PCa). Method Six cases of prostate sarcoma proved pathologically were enrolled in this study. The clinical material and imaging features were compared with those of the PCa. Results (1) Pathological result: Among the 6 prostate sarcomas, 3 were rhabdomyosarcoma, 1 was leiomyosarcoma, and 2 were sarcoma originated from interstitial tissue that could not be classified. (2) Clinical result: The 6 patients of sarcoma were younger (median age 36.5, 15- 71 years) than the patients of PCa (median age 72, 50-78 years) ( P <0.05). Their serum PSA level [median 0.56, (0.20-4.00)×10 -3ng/L] was normal and lower than that of the PCa patients [median 27.80, (1.55-352.00)×10 -3ng/L] ( P <0.01). (3) Imaging result: The imaging appearance of prostate sarcoma was significantly different from that of the PCa. The tumor volume (median 217.46, 64.35-859.04 cm3) was larger than that of PCa (median 41.57, 17.16-179.44 cm3) ( P <0.01), with obliteration of the normal prostate structures. The necrosis was frequent. The PCa appeared as low signal nodules in the peripheral zone on MR T 2-weighted images, with grossly normal structure of the prostate. Excapsular extension was more common in the sarcomas than in the PCa (83.3% vs 66.7%). Conclusion The clinical and imaging features of prostate sarcoma are different from those of prostate adenocarcinoma.