摘要
目的探讨前列腺原发鳞状细胞癌(SCC)的临床病理特征、鉴别诊断、治疗及预后。方法分析1例前列腺原发SCC的临床资料,观察组织学形态、免疫表型,讨论鉴别诊断、治疗、预后并复习相关文献。结果患者82岁,临床表现为反复尿后滴沥伴下腹胀痛及肉眼血尿。直肠指检示前列腺Ⅱ度增大,质韧,中央沟消失。超声检查提示前列腺大小约5 cm×4 cm×2.9 cm,实质回声欠均匀。血清总前列腺特异抗原(TPSA)和游离前列腺特异抗原(FPSA)检测值正常。术中见前列腺两叶增生,双侧叶向尿道腔内突出。术后病理标本为灰白色碎片状组织一堆,总体积6 cm×5 cm×1 cm。镜下见癌细胞大部分排列成不规则片块状,未见确切角化珠及细胞间桥;小部分癌细胞粘附松散,呈条索状浸润于前列腺间质。癌细胞异型性明显,胞质嗜酸性,细胞核呈多形性且深染,部分呈毛玻璃样,染色质较粗,核分裂象及红色核仁易见。免疫组化:P-CK、CK8/18、CK5/6、p63和p40呈(+);AMACR/P504S、UroplakinⅢ、PSA和GATA3呈(-)。患者出院后出现两次血尿症状,目前一般状况好。结论 SCC是一种罕见的特殊类型前列腺癌,好发于前列腺腺癌经内分泌治疗之后。SCC具有高侵袭性、易转移及预后差等特点,早期发现和早期诊治对于提高患者生存率意义重大。检测血清SCC抗原和FGP摄取量对临床病理诊断和预后监测有一定帮助。
Objective To explore clinicopathologic characteristics,differential diagnosis,therapy and prognosis of primary squamous cell carcinoma(SCC) of prostate.Methods Clinical data for a case of prostate primary SCC were analyzed.Histopathologic appearance and immunophenotype were observed.Differential diagnosis,therapy and prognosis were discussed and related literatures were reviewed.Results The 82-years-old patient presented with repetatus drip after urine accompanied with lower abdominal pain and gross hematuria.Digital rectal examination showed enlarged prostateⅡ with tenacious quanlity and median groove could not be touched.Ultrasonic inspection prompted prostate size was about 5.0 cm × 4.0 cm × 2.9 cm and prostate parenchyma had insufficient homogeneous echoe.Serum total and free prostatic specific antigen(PSA) was normal.Prostatic hyperplasia was observed during surgery,with bilateral lobes of prostate protruding into the urethral cavity.The pathological specimen was a pile of grayish-white piecemeal tissue and the total size was 6.0 cm × 5.0 cm × 1.0 cm.Under the microscope,most of the cancer cells were arranged in irregular pieces,and no exact keratinized beads and intercellular bridges were seen.A small percentage of cancer cells loosely adhered and infiltrated into the stroma of prostate with trabs shape.Cancer cells with eosinophilic cytoplasm had obvious atypia.Nuclei were polymorphic and deeply stained,some were ground glass-like.The chromatin was thick.Both mitotic figures and red nucleoli were easily noted.Immunohistochemical staining results showed tumor cells were positive for P-CK,CK8/18,CK5/6,p63 and p40,but negative for AMACR/P504S,PSA,GATA-3 and uroplakin Ⅲ. The patient had hematuria twice after discharge,but remained well condition now.Conclusion Primary SCC is a rare subtype of prostate carcinoma and mainly occurs in prostate adenocarcinoma after endocrine therapy.SCC is highly invasive,easy to metastasize,and has a poor prognosis.Early detection and diagnosis and treatment are significant to improve patient survival.Detection of serum SCC antigen and FGP uptake are helpful to clinical pathological diagnosis and prognosis monitoring.
作者
罗灵芝
张雨涛
LUO Ling-zhi;ZHANG Yu-tao(Department of Pathology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Department of Pathology,Zigong First People’s Hospital,Zigong 643099,China)
出处
《诊断病理学杂志》
2020年第8期552-555,共4页
Chinese Journal of Diagnostic Pathology
关键词
前列腺
鳞状细胞癌
鉴别诊断
Prostate
Squamous cell carcinoma
Differential diagnosis
