前列腺多形性巨细胞腺癌一例报告及文献复习

doi:10.16150/j.1671-2870.2019.02.008

摘要/Abstract

摘要：

目的：探讨前列腺多形性巨细胞腺癌（pleomorphic giant cell adenocarcinom, PGCA）患者的临床病理特征、诊断及鉴别诊断方法和临床预后。方法：收集1例前列腺PGCA患者的临床病理资料、免疫组织化学（免疫组化）表达结果及临床随访情况，并结合相关文献进行探讨。结果：该例前列腺PGCA组织中除典型的高级别前列腺腺泡腺癌成分之外，还有5%的PGCA区域，该区域细胞怪异、巨大，形态多样，可见多核细胞，病理性核分裂相易见。免疫组织化学（免疫组化）检测显示，PGCA肿瘤细胞表达P504S、AE1/AE3、CAM5.2，部分表达前列腺特异抗原（prostate specific antigen，PSA）（60%），不表达前列腺特异性膜抗原（prostate specific membrane antigen，PSMA）、ETS（E-twenty six）相关基因转录因子蛋白及雄激素抗体（androgen receptor，AR）。患者对于术前常规的雄激素阻断治疗反应差，临床分期为PT₄N₀M₀，呈高度侵袭性。结论：前列腺PGCA是一种新进认识的少见肿瘤，组织形态学上以多形性为特征，免疫组化检测结果显示其有不同程度的前列腺特异性抗原丢失，提示肿瘤异质性极大，内分泌治疗效果不佳，有别于常规的前列腺腺癌，诊断及鉴别诊断有一定难度，临床上呈高度侵袭性。因此，识别这一特殊亚型对临床后续治疗及预后判断至关重要。

关键词: 前列腺腺癌, 多形性巨细胞腺癌, 免疫组织化学, HOXB13

Abstract:

Objective: To study the clinicopathological features, diagnosis, differential diagnosis and prognosis of pleomorphic giant cell adenocarcinoma (PGCA) of prostate. Methods: Clinicopathological and follow-up data of one case of PGCA of prostate were collected and analyzed retrospectively, including immunophenotype. Results: In this case, in addition to the component of conventional high-grade prostate acinar adenocarcinoma, there was also a 5% of PGCA in the prostate tissue. The cells in this area were bizarre, giant, pleomorphic with multinucleate and atypical mitotic figures. Immunohistochemistry showed that the PGCA tumor cells expressed P504S, AE1/AE3, CAM5.2, and partially expressed PSA (60%) but not PSMA, ETS related gene or AR. The response of routine androgen blocking therapy before surgery was poor, and the clinical stage was PT₄N₀M₀, which was highly invasive. Conclusions: PGCA of prostate is a newly defined and extremely rare tumor characterized by pleomorphism. The immunohistochemical expression shows different degrees of loss of prostate-specific antigen, suggesting great heterogeneity of the tumor and poor effect of endocrine therapy, which is different from that of conventional prostate adenocarcinoma. The diagnosis and differential diagnosis is difficult. The clinical course is typically highly aggressive. Therefore, to identify this particular subtype is crucial for clinical follow-up treatment and prognosis.

Key words: Prostate adenocarcinoma, Pleomorphic giant cell adenocarcinoma, Immunohistochemistry, HOXB13

中图分类号:

R737.25

何燕燕, 冯砅锦, 蔚青. 前列腺多形性巨细胞腺癌一例报告及文献复习[J]. 诊断学理论与实践, 2019, 18(2): 160-164.

HE Yanyan, FENG Lijin, WEI Qing. Pleomorphic giant cell adenocarcinoma of prostate: clinicopathological analysis of a case and review of literature[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(2): 160-164.

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参考文献 12

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病例号	年龄（岁）	前列腺腺癌病史及 Gleason评分(分)	治疗史	诊断标本类型	前列腺癌 Gleason评分	伴随组织亚型	巨细胞比例（%）	随访
1	77	无	因其他疾病有放疗史	尸检	4+5=9	无	不详	死亡，腰椎胸椎、肝、腹膜后淋巴结转移
2	45	无	无	TURP（+双侧睾丸切除）	4+5=9	无	不详	9个月，死亡，治疗后6个月因复发开始反复尿路堵塞，坐骨、髂骨转移
3	59	4+3=7	立普安	TURP	4+5=9	鳞状细胞癌	5	1年，死亡，带病
4	71	无	无	穿刺活检	5+4=9	小细胞癌	5	2年内进展转移
5	61	无	无	穿刺活检	4+5=9	无	70	1年存活，带病
6	62	4+5=9	放疗	穿刺活检	5+4=9	无	5	第3年短距离放疗后出现巨大会阴处再发病灶
7	66	不详	无	前列腺根治手术	4+5=9	无	5	前列腺被膜+精囊腺侵犯
8	76	无	无	尿道活检	4+5=9	导管内癌	20	3个月，存活，带病
9	81	无	无	TURP	5+4=9	无	60	1年，远处骨转移，死亡
10	55	5+4=9	内分泌+ 化疗+放疗	前列腺根治手术	5+4=9	无	5	存活，17个月累及膀胱、直肠

病例号	巨细胞比例(%)	AE1/AE3 （CAM5.2）	PSA(%)	AR	P53(%)	CD68	β-HCG
1	不详	+	30	0	36	0	0
2	不详	+	20	0	42	0	0
3	5	+	0	不详	不详	不详	不详
4	5	不详	0	不详	90	不详	0
5	70	+	0	不详	50	不详	0
6	5	+	0	不详	不详	不详	不详
7	5	不详	50	不详	0	不详	0
8	20	不详	5	不详	90	不详	0
9	60	不详	+	+	不详	不详	不详
10	5	+	60	0	30	0	0

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