Turbat-Herrera E A, Herrera G A, Gore I, Lott R L, Grizzle W E, Bonnin J M
Department of Pathology, University of Alabama.
Arch Pathol Lab Med. 1988 Nov;112(11):1100-5.
Neuroendocrine differentiation in prostatic neoplasms has in the past been considered extremely uncommon. The histologic neuroendocrine patterns reported previously vary from small cell to carcinoidlike to mixed adenocarcinoma--small cell or carcinoid. The majority of the tumors reported are of the mixed variety. We reviewed 2648 autopsies, revealing 69 prostatic carcinomas, eight with neuroendocrine differentiation (five mixed adenocarcinoma--small-cell carcinoma, two "pure" small cell, and one "pure" carcinoidlike). The mean patient age was 69.5 years. One patient presented with markedly elevated serum corticotropin and another was severely hypercalcemic with elevated serum parathyroid hormone level. Three neoplasms were incidental autopsy findings. The mean survival time, after diagnosis, was 19 months for the other patients. Three of the cases were examined ultrastructurally and showed cytoplasmic processes containing membrane-bound granules in the neuroendocrine component. The areas with neuroendocrine differentiation were positive for markers as follows: neuron-specific enolase, seven of eight; prostate-specific antigen (PSA), none of eight; chromogranin A, seven of eight; synaptophysin, four of eight; and calcitonin, four of eight. Those neoplasms mixed with an adenocarcinoma component showed well-defined PSA positivity in the glandular elements. This study suggests that neuroendocrine differentiation in prostatic neoplasms may be more common than previously thought. Often, the areas with neuroendocrine differentiation are considered to represent poorly differentiated adenocarcinoma. It is important to recognize neuroendocrine components in prostatic carcinomas owing to prognostic and potential therapeutic implications.
前列腺肿瘤中的神经内分泌分化在过去一直被认为极为罕见。先前报道的组织学神经内分泌模式从小细胞型到类癌样再到混合性腺癌——小细胞或类癌不等。报道的大多数肿瘤为混合型。我们回顾了2648例尸检，发现69例前列腺癌，其中8例有神经内分泌分化（5例混合性腺癌——小细胞癌，2例“纯”小细胞癌，1例“纯”类癌样）。患者平均年龄为69.5岁。1例患者血清促肾上腺皮质激素显著升高，另1例严重高钙血症且血清甲状旁腺激素水平升高。3例肿瘤为尸检偶然发现。其他患者诊断后的平均生存时间为19个月。对其中3例进行了超微结构检查，神经内分泌成分显示含有膜结合颗粒的细胞质突起。神经内分泌分化区域对以下标志物呈阳性：神经元特异性烯醇化酶，8例中有7例；前列腺特异性抗原（PSA），8例中无1例；嗜铬粒蛋白A，8例中有7例；突触素，8例中有4例；降钙素，8例中有4例。那些与腺癌成分混合的肿瘤在腺性成分中显示出明确的PSA阳性。这项研究表明，前列腺肿瘤中的神经内分泌分化可能比以前认为的更为常见。通常，神经内分泌分化区域被认为代表低分化腺癌。认识前列腺癌中的神经内分泌成分很重要，因为其具有预后和潜在的治疗意义。
