Yokota Narushi, Hashimoto Yasunobu, Iida Syoichi, Kondo Tunenori, Goya Nobuyuki, Toma Hiroshi, Tanabe Kazunari
Department of Urology, Tokyo Women's Medical University.
Hinyokika Kiyo. 2009 Aug;55(8):517-21.
A 64-year-old man, was admitted to the Department of Gastroenterology at another hospital in October, 2005 because of constipation and urinary retention. Endoscopic and computed tomographic (CT) examinations of biopsy specimens obtained from the rectal mucous membrane which appeared to be thickened revealed evidence of proctitis but no evidence of malignancy. The patient was referred to our hospital because of a high prostate specific anyigen (PSA) level (74.17 ng/ml), and hydronephrosis accompanied with hydroureter at the right side. Biopsy specimens taken from a prostatic tumor through a transrectal route showed histological features consistent with anaplastic adenocarcinoma which was positively stained with PSA antibody. We treated the patient with maximium androgen blackade (MAB), resulting in a decrease in plasma PSA level and amelioration of constipation as well. A 77-year-old man, visited a hospital because of constipation and high plasma carcinoembryonic antigen and carbohydrate antigen (CA) 19-9 values in May, 2005, and was diagnosed as having hyperplastic mucous membrane and atypical glands of the rectum by means of a rectal biopsy. Having been referred to our hospital, the patient received a prostate biopsy, specimens of which revealed moderately differentiated adenocarcinoma with negative PSA staining. A pelvic evisceration was performed. The eviscerated samples showed no abnormality in the rectal mucous membrane but cancer with light PSA staining in the prostatic ducts. The hormone therapy was initiated in the patient under the diagnosis of anaplastic cancer in the prostate. Since the therapy for the invasion of prostatic cancer on the rectum differs markedly from that for a primary tumor in the rectum, it is very important to differentiate accurately the one from the other.
一名64岁男性，因便秘和尿潴留于2005年10月入住另一家医院的胃肠病科。对从增厚的直肠黏膜获取的活检标本进行内镜和计算机断层扫描（CT）检查，结果显示为直肠炎，但未发现恶性肿瘤迹象。该患者因前列腺特异性抗原（PSA）水平较高（74.17 ng/ml）以及右侧肾积水伴输尿管积水转诊至我院。经直肠途径从前列腺肿瘤获取的活检标本显示组织学特征符合间变性腺癌，PSA抗体呈阳性染色。我们对该患者采用最大雄激素阻断（MAB）治疗，血浆PSA水平降低，便秘也有所改善。一名77岁男性，因便秘以及2005年5月血浆癌胚抗原和糖类抗原（CA）19-9值升高就诊于一家医院，经直肠活检诊断为直肠黏膜增生和非典型腺体。转诊至我院后，该患者接受了前列腺活检，标本显示为中度分化腺癌，PSA染色阴性。进行了盆腔脏器切除术。切除的标本显示直肠黏膜无异常，但前列腺导管中有轻度PSA染色的癌。该患者在诊断为前列腺间变性癌后开始接受激素治疗。由于前列腺癌侵犯直肠的治疗与直肠原发性肿瘤的治疗明显不同，准确区分两者非常重要。
