BERKELEY, CA (UroToday.com) - Between 1990 and 2010, more than 1000 cases of prostate cancer presented in our hospital, of which only 1 case was seen with five different histological structures of prostate cancer. Our report is as follows.
The 84-year-old male patient presented with difficulty urinating, dribbling urine for 1 year, and exhibiting hematuria for 8 months, resulting in increased hospital admissions. A B-rectal examination, CT (cycle threshold), magnetic resonance imaging (MRI), digital rectal examination (DRE), and prostate specific antigen (PSA) > 120 ng/ml, 75.24 ng/ml 14 days previous) indicated prostate cancer. Diagnosis after a biopsy puncture was cribriform carcinoma. Gleason grade was 8 points. The cancer had invaded the bladder and bilateral seminal vesicle. Tumor cells appeared once in the urine during 3 examinations. The emission computed tomography (ECT) showed abnormal uptake areas in the T10. The patient’s heart was not good. Considering the general condition of the patient under epidural anesthesia, transurethral resection was performed to modify urinary symptoms. During operation, 4 pieces of the pedicle gland were found in the bladder. The surgeon cut a suspicious tumor, and the postoperative pathology showed a gray cable organization, 4 cm by 3 cm by 2 cm, and prostate adenocarcinoma (cribriform carcinoma, invasive carcinoma, signet ring cell carcinoma, acinar carcinoma, and ductal carcinoma). Gleason grade was 9 points. The IHC (immunohistochemistry) results were PSA+ and PAP+. The patient received a postoperative treatment of bicalutamide and goserelin. The PSA was 12.56 ng/ml 3 months after operation, and it decreased slowly during the treatment. However, the bladder and the nephric ducts were invaded extensively after 10 months. Oxaliplatin and docetaxel didn’t work well. Then patient’s physical health began to decline and he died after 1 year.
In older men, prostate cancer has a high incidence of tumors, and more than 95% of prostate cancer is adenocarcinoma,[1] a common tumor of the prostate gland. It is an epithelial type divided into the following:[2]
1) acinar adenocarcinoma,
2) carcinoma with spindle cell differentiation,
3) ductal adenocarcinoma, and
4) prostatic intraepithelial neoplasia.
Final prostate cancer diagnosis depends on pathologic biopsy and the resulting microscopic structural abnormalities[2] The cavity nipple or acinar branching structure disappears, resulting in a normal round or oval glandular cavity. The resulting prostate cancer structure features: 1) the acinar type, 2) the sieve type, and 3) the entity type.
The cases of prostatic adenocarcinoma may contain cribriform carcinoma, acinar carcinoma, invasive cancer, and other common histological structures. Ductal carcinoma and mucinous carcinoma are relatively rare in the structure. Our patient’s PSA was significantly elevated, resulting in further research and discussion. Prostatic duct carcinoma and acinic carcinoma are closely related, and ductal adenocarcinoma shows a higher malignant degree.[3-6] Although mucinous adenocarcinoma (signet ring cell carcinoma) was reported in the literature, malignancy is not high and the prognosis is better.[7-8] Recent studies have shown that bone metastases readily occur in Gleason grade 5 mucinous adenocarcinoma, and the prognosis is poor.[2] Our results seemed highly malignant when considering the significant invasive growth in this case. In addition, this example, to a certain extent, suggested this might be a multicenter process.
In terms of treatment, we used TURP-combined castration rather than radical resection since the tumor was found in a later stage, the patient was older, and his systemic conditions could not tolerate radical surgery.
References:
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- 徐勇，张志宏主编，前列腺癌（现代肿瘤临床诊治丛书），2009年7月第1版，北京：科学技术文献出版社，2009;230-244.
- Lee TK, Miller JS, Epstein JI. Rare histological patterns of prostatic ductal adenocarcinoma. 2010;42(4):319-324. PMID: 20438402.
- Melicow MM and Pachter MR．Endometrial carcinoma of proxtatic utricle (uterus masculinus). Cancer．1967;20:1715-1722．PMID: 4168340.
- Morgan TM, Welty CJ, Vakar-Lopez F, et al. Ductal adenocarcinoma of the prostate: increased mortality risk and decreased serum prostate specific antigen. J Urol. 2010;184(6):2303-2307. PMID: 20952027.
- Samaratunga H, Delahunt B.Ductal adenocarcinoma of the prostate: current opinion and controversies. Anal Quant Cytol Histol. 2008;30(4):237-246. PMID: 18773743.
- Saito S，Lwaki H．Mucin-producing Carcinoma of the prostate：review of 88 cases[J]. Urology. 1999;54(1)141-144．PMID: 10414741.
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Written by:
Chen Jing,1 Quan Changyi,2 Chang Jiwu,1 Yang Yuming,1 Li Bo,1 Chang Wenliang,1, Wang Jiang,1, and Niu Yuanjie1* as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
1Tianjin Institute of Urology, Tianjin Medical University, 2Department of Urology in the Secondary Hospital of Tianjin Medical University; Pingjiang Road 23, Hexi District, Tianjin 300211 Q.P.R China)
*Corresponding Author, E-mail .
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