Heresi Gustavo A, Wang Jingcheng, Taichman Russell, Chirinos Julio A, Regalado Jacinto J, Lichtstein Daniel M, Rosenblatt Joseph D
Department of Medicine, University of Miami School of Medicine, Miami, FL 33101, USA.
Urol Oncol. 2005 Jul-Aug;23(4):261-7. doi: 10.1016/j.urolonc.2005.02.004.
Generalized lymphadenopathy is a rare presentation of prostate cancer. We report a case and review reported cases in the literature. Because of the association of chemokine receptor expression with specific metastatic patterns, we tested for expression of chemokine receptors known to mediate migration to lymph nodes.
We performed a MEDLINE (National Library of Medicine, Bethesda, MD) database search for case reports during the last 32 years using "prostate cancer," "lymphadenopathy," "metastatic to lymph nodes," and "mimicking lymphoma" as keywords. Expression of the CXCR4 and CCR7 chemokine receptors was assessed by immunohistochemistry. Laser capture microdissection and reverse transcription polymerase chain reaction for CXCR4 were used to exclude nonspecific binding.
Of 153 patients with prostate cancer presenting with lymphadenopathy (LAD) described in the literature, 67 (44%) presented with supraclavicular adenopathy, 29 (19%) retroperitoneal, 22 (14%) mediastinal, 15 (10%) cervical, 9 (6%) inguinal, and 2 (1%) axillary LAD. Only 9 patients presenting with generalized LAD have been previously reported. Monoclonal antibodies to CCR7 showed intense staining in the patient's tumor epithelium. Little or no staining was observed for CXCR4. Reverse transcription polymerase chain reaction for chemokine receptors on ribonucleic acid (RNA) recovered from the patient's sample failed to express messenger RNA for CXCR4 but did express messenger RNA for CCR1, CCR4, and CCR5.
Prostate cancer may present on rare occasions with generalized adenopathy. Variable expression of chemokine receptors may be associated with organ specific patterns of metastasis. In this case, expression of CCR7 may have accounted for the unusual predilection of this patient's prostate cancer for lymph nodes.
全身性淋巴结病是前列腺癌的一种罕见表现形式。我们报告一例病例并回顾文献中报道的病例。由于趋化因子受体表达与特定转移模式相关，我们检测了已知介导向淋巴结迁移的趋化因子受体的表达情况。
我们使用“前列腺癌”“淋巴结病”“转移至淋巴结”和“酷似淋巴瘤”作为关键词，对医学文献数据库（美国国立医学图书馆，马里兰州贝塞斯达）过去32年的病例报告进行了检索。通过免疫组织化学评估趋化因子受体CXCR4和CCR7的表达情况。采用激光捕获显微切割和CXCR4的逆转录聚合酶链反应来排除非特异性结合。
文献中描述的153例出现淋巴结病（LAD）的前列腺癌患者中，67例（44%）出现锁骨上淋巴结病，29例（19%）出现腹膜后淋巴结病，22例（14%）出现纵隔淋巴结病，15例（10%）出现颈部淋巴结病，9例（6%）出现腹股沟淋巴结病，2例（1%）出现腋窝淋巴结病。此前仅报道过9例出现全身性LAD的患者。针对CCR7的单克隆抗体在患者肿瘤上皮中显示出强烈染色。CXCR4几乎没有或未观察到染色。对从患者样本中回收的核糖核酸（RNA）进行趋化因子受体的逆转录聚合酶链反应，结果未检测到CXCR4的信使核糖核酸（mRNA）表达，但检测到了CCR1、CCR4和CCR5的mRNA表达。
前列腺癌在极少数情况下可能表现为全身性淋巴结病。趋化因子受体的可变表达可能与器官特异性转移模式相关。在本病例中，CCR7的表达可能是该患者前列腺癌对淋巴结有异常偏好的原因。
