前列腺癌是男性中最常见的恶性肿瘤之一。这些肿瘤大多数是腺癌。浆细胞样是先前在泌尿生殖系统研究中描述的腺癌的一种罕见变体,其特征是肿瘤细胞的浆细胞样外观具有丰富的细胞质和异常放置的超色核。然而,据我们所知,浆细胞样腺癌在前列腺中很少被描述。该报告描述了通过活检诊断的前列腺浆细胞样腺癌的新病例,并总结了有关泌尿生殖系统浆细胞样特征的已知文献。一名62岁的男性患者出现尿潴留到医院,血尿,虚弱和减肥。直肠指检显示不规则肿大。实验室发现显示前列腺特异性抗原(PSA;43.6ng/ml)水平升高。经直肠超声显示右侧精囊浸润。收集前列腺肿瘤核心活检并送去诊断。组织学检查显示高级别前列腺腺癌Gleason评分为5+5(总分10)。肿瘤细胞具有浆细胞样外观,具有丰富的细胞质和异常放置的超色核。免疫组织化学表型的特征在于细胞角蛋白(CK)AE1/AE3和PSA的大量阳性。相比之下,肿瘤细胞p63,CK34BE12和GATA结合蛋白3(尿路上皮标志物)阴性,突触素(神经内分泌标记)。肿瘤细胞对E-cadherin也呈阴性,这特别表明CDH1改变。据我们所知,这是通过活检诊断的前列腺浆细胞样腺癌的首次描述,显示不规则的免疫表型,可能表明体细胞CDH1改变。与泌尿生殖系统的其他肿瘤不同,前列腺癌的一种新的罕见变体的出现可能有助于改善对这种罕见的组织学模式的理解,由于这种诊断的临床和预后意义,这种组织学模式也可能是强制性的。
Prostate cancer is one of the most commonly diagnosed malignancies in men. Most of these tumors are adenocarcinomas. Plasmacytoid is a rare variant of adenocarcinoma described by previous studies in the genitourinary system and is characterized by the plasmacytoid appearance of tumor cells with abundant cytoplasm and abnormally placed hyperchromatic nuclei. However, to the best of our knowledge, plasmacytoid adenocarcinoma has rarely been described in the prostate. This report describes a new
case of plasmacytoid adenocarcinoma of the prostate diagnosed by biopsy and summarizes the known literature on plasmacytoid features in the genitourinary system. A 62-year-old male patient presented to the hospital with urinary retention, hematuria, weakness and weight loss. The digital rectal examination revealed an irregular enlargement. Laboratory findings showed elevated levels of prostate specific antigen (PSA; 43.6 ng/ml). Transrectal ultrasound showed invasion of the right seminal vesicle. Prostate tumor core biopsies were collected and sent for diagnosis. Histological examination revealed a high-grade prostatic adenocarcinoma Gleason score of 5+5 (total score 10). The tumor cells had a plasmacytoid appearance with abundant cytoplasm and abnormally placed hyperchromatic nuclei. The immunohistochemical phenotype was characterized by abundant positivity for cytokeratin (CK)AE1/AE3 and PSA. By contrast, tumor cells were negative for p63, CK 34BE12 and GATA binding protein 3 (urothelial markers), synaptophysin (neuroendocrine marker). Tumor cells were also negative for E-cadherin, which is particularly indicative of CDH1 alterations. To the best of our knowledge, this is the first description of a plasmacytoid adenocarcinoma of the prostate diagnosed by biopsy, showing an irregular immunophenotype that may indicate somatic CDH1 alterations. The presentation of a novel rare variant of prostatic carcinoma that differs from other neoplasms of the genitourinary system may contribute to an improved understanding of this uncommonly found histological pattern that may also be mandatory due to the clinical and prognostic implications of this diagnosis.