Natsuyama Takao, Mitsui Yozo, Uetani Masato, Ohta Shigeyuki, Inoue Masafumi, Akakura Koichiro
Department of Urology, Chiba-Nishi General Hospital, 270-2251 Chiba, Japan.
Department of Urology, Japan Community Health Care Organization, Tokyo Shinjuku Medical Center, Tokyo, Japan.
Case Rep Urol. 2019 Jun 9;2019:3454037. doi: 10.1155/2019/3454037. eCollection 2019.
We report an extremely rare case of an alpha-fetoprotein- (AFP-) producing female primary urethral adenocarcinoma with neuroendocrine differentiation (NED). The patient was a 65-year-old woman with a 2-year history of urinary frequency and voiding difficulty. Enhanced computed tomography showed an approximately 3.0×5.0-cm mass around the proximal urethra and bladder neck. Of examined tumor markers, serum AFP was elevated (48.3 ng/mL), while others including carcinoembryonic antigen were within a normal range. Transurethral resection of the tumor led to a diagnosis of carcinosarcoma of the urethra, with a radical cystourethrectomy and ileal conduit formation subsequently performed. The pathological assessment was poorly differentiated adenocarcinoma in the urethra. Immunostaining showed tumor cells strongly positive for AFP. In addition, some cancer cells were positive for CD56, chromogranin A, and synaptophysin, indicating focal NED. The tumor was finally diagnosed as an AFP-producing urethral adenocarcinoma with NED. Serum AFP was immediately normalized after surgery and no sign of tumor recurrence has been noted 2 years postoperatively.
我们报告了一例极为罕见的伴有神经内分泌分化（NED）的产甲胎蛋白（AFP）的女性原发性尿道腺癌病例。患者为一名65岁女性，有2年尿频及排尿困难病史。增强计算机断层扫描显示尿道近端和膀胱颈周围有一个约3.0×5.0厘米的肿块。在所检测的肿瘤标志物中，血清AFP升高（48.3 ng/mL），而包括癌胚抗原在内的其他标志物均在正常范围内。经尿道肿瘤切除术导致诊断为尿道癌肉瘤，随后进行了根治性膀胱尿道切除术并形成回肠导管。病理评估为尿道低分化腺癌。免疫染色显示肿瘤细胞AFP呈强阳性。此外，一些癌细胞CD56、嗜铬粒蛋白A和突触素呈阳性，表明存在局灶性NED。该肿瘤最终被诊断为伴有NED的产AFP尿道腺癌。术后血清AFP立即恢复正常，术后2年未发现肿瘤复发迹象。
