Vetsch Gabi, Baumann Christa K, Kläy Marco, Leupin Nicolas, Rentsch Cyrill, Mueller-Garamvölgyi Esther, Bürgi Ulrich, Schiemann Uwe
Klinik und Poliklinik für Allgemeine Innere Medizin, Inselspital Bern, Universität Bern, Schweiz.
Med Klin (Munich). 2008 Apr 15;103(4):245-8. doi: 10.1007/s00063-008-1034-y.
Malignant lymphoma of the prostate is rare. In the literature, about 165 cases with either a primary lymphoma of the prostate or secondary infiltration of the prostate by a lymphoma are described.
The case of a 59-year-old patient with an irregular tumor in the prostatic region, but normal prostate-specific antigen (PSA), a fracture in the vertebral column and a bilateral enlargement of the suprarenal glands is presented. Repetitive prostate biopsy revealed the diagnosis of a diffuse large B cell lymphoma. Further staging examinations gave hints to an epidural infiltration. A polychemotherapy including intrathecal drug applications was initiated. Staging after four therapeutic cycles already showed good partial remission of all lymphoma manifestations. After two further therapeutic cycles, a CT scan showed a small rest of prostatic bulk, but PET-CT did not detect vital lymphatic tissue (complete remission).
In cases of irregular prostatic enlargements, carcinoma has to be considered as the most frequent diagnosis. Nevertheless, also a solitary lymphoma or infiltration of the prostate by a systemic lymphoma has to be taken into account, especially if the PSA value is in the normal range.
前列腺恶性淋巴瘤较为罕见。文献中描述了约165例原发性前列腺淋巴瘤或淋巴瘤继发浸润前列腺的病例。
本文介绍了一名59岁患者，其前列腺区域有不规则肿瘤，但前列腺特异性抗原（PSA）正常，伴有脊柱骨折和双侧肾上腺肿大。重复前列腺活检确诊为弥漫性大B细胞淋巴瘤。进一步的分期检查提示存在硬膜外浸润。开始进行包括鞘内给药的多药化疗。四个治疗周期后的分期显示所有淋巴瘤表现均有良好的部分缓解。再经过两个治疗周期后，CT扫描显示前列腺体积有一小部分残留，但PET-CT未检测到有活性的淋巴组织（完全缓解）。
在前列腺不规则肿大的病例中，癌通常是最常见的诊断。然而，也必须考虑孤立性淋巴瘤或系统性淋巴瘤浸润前列腺的情况，特别是当PSA值在正常范围内时。
