表现为双侧颈部淋巴结肿大的前列腺肉瘤样癌：罕见病例报告,African Journal of Urology

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表现为双侧颈部淋巴结肿大的前列腺肉瘤样癌：罕见病例报告
African Journal of Urology ( IF 0.5 ) Pub Date : 2022-03-17 , DOI: 10.1186/s12301-022-00274-x
K. I. Jayasinghe ₁ , A. H. M. G. B. Abeysinghe ₂

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前列腺肉瘤样癌（在 2016 年最新的 WHO 分类中也称为癌肉瘤）是一种具有上皮和间充质分化的双相恶性肿瘤 [1]。肉瘤样癌是一种罕见的肿瘤，在 WHO 分类中被认为是腺泡腺癌的一种变体，迄今为止文献中报道的病例不到 200 例 [2]。以双侧颈部淋巴结沉积为首发临床表现的前列腺肉瘤样癌更为罕见，文献未见报道；因此，据我们所知，这是第一个此类案例报告。我们报告了一例前列腺肉瘤样癌，患者为一名 72 岁的斯里兰卡男子，他出现双侧颈部淋巴结肿大。直肠指检 (DRE) 发现他有硬结节性前列腺。此外，腹部超声扫描 (USS) 显示存在主动脉旁淋巴结肿大。右侧颈部淋巴结切除活检显示上皮样癌组织形态学沉积，免疫组化标志物 (IHCm) PSA 呈斑片状强阳性。他的血清 PSA 值为 48 ng/ml（参考值 < 5.40 ng/ml）。对比增强计算机断层扫描 (CECT) 显示前列腺轻度肿大，轮廓不规则，颈胸椎和腰骶椎硬化性病变和全身淋巴结肿大。经直肠超声引导的前列腺活检显示肉瘤样癌。诊断为前列腺播散性肉瘤样癌。患者接受了双侧睾丸切除术，血清 PSA 值为 5。两个月后 4 ng/ml。他在诊断后存活了六个月，目前正在接受多西他赛化疗以治疗播散性疾病。肉瘤样癌可表现为颈部淋巴结肿大而无下尿路症状。对颈淋巴结肿大的老年患者，主张进行血清PSA、DRE和经直肠超声检查以排除前列腺癌。免疫组织化学标志物是诊断前列腺肉瘤样癌原发性肿瘤和继发性沉积所必需的。提倡血清PSA、DRE和经直肠超声检查排除前列腺癌。免疫组织化学标志物是诊断前列腺肉瘤样癌原发性肿瘤和继发性沉积所必需的。提倡血清PSA、DRE和经直肠超声检查排除前列腺癌。免疫组织化学标志物是诊断前列腺肉瘤样癌原发性肿瘤和继发性沉积所必需的。

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Sarcomatoid carcinoma of the prostate presenting as bilateral cervical lymphadenopathy: a rare case report

Sarcomatoid carcinoma (also called carcinosarcoma in the latest WHO classification 2016) of the prostate gland is a biphasic malignant neoplasm which exhibits epithelial and mesenchymal differentiation [1]. Sarcomatoid carcinoma is a rare tumour, considered as a variant of acinar adenocarcinoma in the WHO classification, with less than 200 reported cases in the literature to date [2]. Sarcomatoid carcinoma of prostate presenting with bilateral cervical lymph node deposits as the first clinical manifestation, is even rarer, and reported cases were not found in the literature; hence, this is the first case report of such, to the best of our knowledge. We report a case of sarcomatoid carcinoma of the prostate in a 72-year-old Sri Lankan man who presented with bilateral cervical lymphadenopathy. He had hard nodular prostate on digital rectal examination (DRE). Ultrasound scan of abdomen (USS) revealed the presence of paraaortic lymphadenopathy, in addition. The excision biopsy of the right cervical lymph node revealed deposit of a carcinoma of epithelioid histomorphology, which showed patchy strong positivity for immunohistochemical marker (IHCm), PSA. His serum PSA value was 48 ng/ml (reference < 5.40 ng/ml). Contrast-enhanced computed tomography (CECT) showed mildly enlarged prostate gland with irregular outline, sclerotic lesions in cervico-thoracic and lumbosacral vertebrae and generalized lymphadenopathy. Transrectal ultrasound guided biopsy of the prostate revealed sarcomatoid carcinoma. Disseminated sarcomatoid carcinoma of prostate was diagnosed. The patient has undergone bilateral orchidectomy, marking a serum PSA value of 5.4 ng/ml two months thereafter. He is surviving for six months after diagnosis and is currently under chemotherapy with docetaxel for the disseminated disease. Sarcomatoid carcinoma can present with cervical lymphadenopathy with absent lower urinary tract symptoms. In elderly patients with cervical lymphadenopathy, serum PSA, DRE and trans-rectal ultrasound scan are advocated to rule out prostate cancer. Immunohistochemical markers are required for the diagnosis of primary tumour and secondary deposit of sarcomatoid carcinoma of prostate.

更新日期：2022-03-17

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