PDF(Pubmed)
Abstract：
Neuroendocrine prostate neoplasms, encompassing small cell carcinoma, carcinoid, and large cell carcinoma, are infrequently observed in malignant prostate tumors. The occurrence of large cell neuroendocrine prostate cancer (LCNEPC) is exceedingly rare. In this study, the patient initially presented with a persistent dysuria for a duration of one year, accompanied by a serum prostate-specific antigen (PSA) level of 17.83ng/mL. Prostate magnetic resonance imaging (MRI) and chest computed tomography (CT) scan showed that a neoplastic lesion was considered, and prostate biopsy confirmed prostate adenocarcinoma with a Gleason score of 7 (4 + 3). Then, thoracoscopic lung tumor resection was performed, and the pathological examination revealed the presence of primary moderately differentiated invasive adenocarcinoma of the lung and metastatic prostate adenocarcinoma, the Gleason score was 8 (4 + 4). After 1 year of endocrine therapy with goserelin acetate and bicalutamide, he underwent a laparoscopic radical prostatectomy (LRP), the pathological report indicated the presence of adenocarcinoma mixed with NE carcinoma. Two months after the LRP, the patient experienced gross hematuria and sacral tail pain. Further examination revealed multiple metastatic lesions throughout the body. He also underwent transurethral resection of bladder tumor (TURBT) for bladder tumor and received etoposide+ cisplatin chemotherapy three weeks post-surgery. The patient eventually died of multi-organ failure due to myelosuppression after chemotherapy. This case report presents an uncommon instance of LCNEPC with widespread systemic metastases, while also providing a comprehensive review of existing literature to facilitate improved management and treatment strategies for similar patients in subsequent cases.
摘要：
神经内分泌前列腺肿瘤,包括小细胞癌，类癌,和大细胞癌，很少在恶性前列腺肿瘤中观察到。大细胞神经内分泌前列腺癌（LCNEPC）的发生极为罕见。在这项研究中,患者最初出现持续的排尿困难，持续时间为一年，伴随着17.83ng/mL的血清前列腺特异性抗原（PSA）水平。前列腺磁共振成像（MRI）和胸部计算机断层扫描（CT）扫描显示考虑肿瘤病变，前列腺活检证实为前列腺腺癌，Gleason评分为7分（4+3）。然后，胸腔镜肺肿瘤切除术，病理检查显示存在原发性中分化的肺浸润性腺癌和转移性前列腺腺癌，Gleason评分为8(4+4)。醋酸戈舍瑞林和比卡鲁胺内分泌治疗1年后，他接受了腹腔镜前列腺癌根治术(LRP),病理报告提示腺癌与NE癌混合。LRP两个月后,患者出现肉眼血尿和骶尾部疼痛。进一步检查发现全身多处转移性病变。他还接受了经尿道膀胱肿瘤电切术（TURBT）治疗膀胱肿瘤，并在术后三周接受了依托泊苷+顺铂化疗。患者最终死于化疗后骨髓抑制导致的多器官功能衰竭。该病例报告提供了一个罕见的LCNEPC，伴有广泛的全身转移，同时还提供了对现有文献的全面回顾，以促进后续病例中类似患者的管理和治疗策略的改进。
