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目的探讨前列腺小细胞癌的临床、病理特征及治疗方法。方法总结2例前列腺小细胞癌患者的临床资料并进行文献复习。例1,50岁,因排尿困难伴会阴部疼痛3个月入院。直肠指检前列腺Ⅲ度(5．0 cm×6．0 cm)增生,质硬,表面欠光滑。血清PSA 0．31 ng／ml,fPSA 0．09ng／ml。B超示低回声块,CT示前列腺密度不均。经直肠穿刺活检示前列腺癌,行前列腺癌根治术。例2,82岁,因排尿困难伴间歇性血尿4个月入院。直肠指检前列腺Ⅱ度(4．0 cm×5．0 cm)增生,质硬伴多发性结节,表面欠光滑。血清PSA 2．61 ng／ml,fPSA 0．05ng／ml。B超示低回声块,CT示前列腺密度不均,精囊及膀胱颈部受侵犯。经直肠穿刺活检示前列腺小细胞癌,行双睾切除术加TURP。结果2例术后病理均诊断为前列腺小细胞癌。肿瘤呈弥漫性片巢状结构,伴大片凝固性坏死,核小、燕麦状或圆形、染色深、核仁不明显、胞质少,类似肺小细胞癌。精囊及膀胱颈部均有肿瘤细胞浸润。免疫组化染色检查:LCA、L-26、34βE12(-),PSA、AE1／AE3、AR(+),CA、S-100(±)。例1术后1个月死于广泛肺转移,例2术后3个月发现后腹膜转移,仍在随访中。结论前列腺小细胞癌少见,确诊依靠临床及病理表现。对早期前列腺小细胞癌,根治性前列腺癌切除术加激素及化疗是可行的,晚期患者则无较满意的治疗方法,且预后差。
Objective To investigate the clinical, pathological features and treatment of prostatic small cell carcinoma. Methods The clinical data of 2 patients with small cell carcinoma of the prostate were summarized and reviewed. Example 1, 50 years old, due to dysuria with genital pain 3 months admitted to hospital. Rectal fingerprints prostate Ⅲ degree (5.0 cm × 6.0 cm) hyperplasia, hard, less smooth surface. Serum PSA 0.31 ng / ml, fPSA 0.09 ng / ml. B ultrasound showed low echo block, CT showed uneven prostate density. Transrectal biopsy of prostate cancer, prostatectomy radical prostatectomy. Example 2, 82 years old, due to dysuria with intermittent hematuria 4 months admission. Prostate Prostate Ⅱ degree (4.0 cm × 5.0 cm) hyperplasia, hard with multiple nodules, the surface is not smooth. Serum PSA 2.61 ng / ml, fPSA 0.05 ng / ml. B ultrasound showed low echo block, CT showed uneven density of the prostate, seminal vesicle and bladder neck by violations. Transrectal biopsy of small cell prostate cancer, line double testosterone plus TURP. Results Two cases of postoperative pathology were diagnosed as small cell carcinoma of the prostate. Tumor was diffuse nested structure, with large coagulation necrosis, nuclear small, oat or round, deep staining, nucleoli are not obvious, less cytoplasm, similar to small cell lung cancer. Seminal vesicle and bladder neck tumor cell infiltration. Immunohistochemical staining: LCA, L-26,34βE12 (-), PSA, AE1 / AE3, AR (+), CA, S-100 (±). Example 1 1 month after surgery died of extensive lung metastases, 2 cases were found after 3 months of peritoneal metastasis, are still under follow-up. Conclusions Small cell carcinoma of the prostate is rare and its diagnosis depends on clinical and pathological findings. For early small cell carcinoma of the prostate, radical prostatectomy plus hormone and chemotherapy is feasible, advanced patients are no more satisfactory treatment, and the prognosis is poor.