Morikawa Teppei, Nagata Masayoshi, Tomita Kyoichi, Kitamura Tadaichi, Goto Akiteru, Chong Ja-Mun, Fukayama Masashi
Department of Human Pathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Pathol Int. 2006 Mar;56(3):158-61. doi: 10.1111/j.1440-1827.2006.01938.x.
Reported herein is an unusual case of prostatic phyllodes tumor with exuberant glandular hyperplasia that led to misdiagnosis of adenocarcinoma. The tumor was detected in a 52-year-old man who had a 1 year history of dysuria. Adenocarcinoma of the prostate was diagnosed from a needle biopsy specimen. The patient received hormonal therapy for 6 months and underwent radical prostatectomy. Histologically, the tumor had an atypical stromal cell proliferation and elongated slit-like glands characteristic of a phyllodes tumor. The tumor was also accompanied by a florid proliferation of small acini, most of which lacked basal cells, a common manifestation of adenocarcinoma in the overall tumor area. The following features of the resected tumor were helpful for concluding that these acini were benign: lack of cytological anaplasia in spite of structural atypia, presence of scattered basal cells confirmed by immunohistochemistry (high-molecular-weight cytokeratin), and histological transition from these acini to apparently benign slit-like glands. The final diagnosis was then made as 'phyllodes tumor of the prostate with exuberant glandular hyperplasia'. Atypical stromal cells might provide a clue for the recognition of this rare tumor at initial diagnosis by needle biopsy.
本文报道了一例罕见的前列腺叶状肿瘤，伴有旺盛的腺体增生，导致腺癌误诊。该肿瘤在一名52岁有1年排尿困难病史的男性中被发现。经针吸活检标本诊断为前列腺腺癌。患者接受了6个月的激素治疗并接受了根治性前列腺切除术。组织学上，肿瘤具有非典型的间质细胞增殖和叶状肿瘤特有的细长裂隙状腺体。肿瘤还伴有小腺泡的旺盛增殖，其中大多数缺乏基底细胞，这是整个肿瘤区域腺癌的常见表现。切除肿瘤的以下特征有助于确定这些腺泡是良性的：尽管结构异型但缺乏细胞学间变，免疫组织化学（高分子量细胞角蛋白）证实存在散在的基底细胞，以及这些腺泡向明显良性的裂隙状腺体的组织学转变。最终诊断为“伴有旺盛腺体增生的前列腺叶状肿瘤”。非典型间质细胞可能为针吸活检初始诊断时识别这种罕见肿瘤提供线索。
