Sismeiro Rita, Brito Monteiro Margarida, Negrão Catarina, Tomás Tiago, Jonet Marta
Internal Medicine, Hospital Prof. Doutor Fernando Fonseca, Amadora, PRT.
Oncology, Hospital Prof. Doutor Fernando Fonseca, Amadora, PRT.
Cureus. 2022 Apr 19;14(4):e24283. doi: 10.7759/cureus.24283. eCollection 2022 Apr.
Treatment-emergent transformed neuroendocrine prostate cancer (NEPC) is a highly aggressive type of prostate cancer that may arise from typical adenocarcinoma of the prostate, which is associated with rapidly progressive disease involving visceral sites and refractoriness to hormonal therapy. We present the case of a 74-year old male with a known history of stable prostate adenocarcinoma treated with transurethral prostate resection, local radiotherapy (RT), and androgen deprivation therapy (ADT) in 2020 who presented to the emergency room with complaints of shoulder and anterior chest pain, dyspnoea, and fatigue. Upon examination, a solid, adherent breast mass and infra-clavicular adenopathy were palpable. Thoracic computed tomography (CT) scan showed adenopathies in multiple thoracic chains, bilateral pulmonary nodular opacities, multiple osteolytic lesions, and bilateral enlargement of retro areolar tissue. A staging CT scan revealed further hepatic and penile lesions. Breast mass biopsy was compatible with small cell neuroendocrine cancer. Biopsies of the prostate, penis, lymph nodes, and bronchus were also performed. Histology of the prostate showed focal infiltration by the known adenocarcinoma while all others documented extensive infiltration by neuroendocrine carcinoma, whose morphology and immunohistochemical profile were identical to that of the breast. This case highlights the challenges a diagnosis of neuroendocrine prostate cancer might pose, and the aggressiveness of this type of cancer, which frequently presents with advanced disease and is associated with poor outcomes.
治疗中出现的转化型神经内分泌前列腺癌（NEPC）是一种侵袭性很强的前列腺癌类型，可能由前列腺典型腺癌发展而来，与涉及内脏部位的快速进展性疾病以及对激素治疗的耐药性有关。我们报告一例74岁男性病例，该患者有稳定的前列腺腺癌病史，2020年接受了经尿道前列腺切除术、局部放疗（RT）和雄激素剥夺治疗（ADT），因肩部和前胸疼痛、呼吸困难及疲劳就诊于急诊室。检查时可触及一个质地坚硬、与周围组织粘连的乳腺肿块及锁骨下淋巴结肿大。胸部计算机断层扫描（CT）显示多个胸段淋巴结肿大、双侧肺部结节状混浊、多个溶骨性病变以及乳晕后组织双侧增大。分期CT扫描显示肝脏和阴茎有进一步病变。乳腺肿块活检结果符合小细胞神经内分泌癌。同时对前列腺、阴茎、淋巴结和支气管进行了活检。前列腺组织学检查显示已知的腺癌有局灶性浸润，而其他所有组织均显示神经内分泌癌广泛浸润，其形态和免疫组化特征与乳腺的相同。该病例凸显了神经内分泌前列腺癌诊断可能带来的挑战，以及这种癌症的侵袭性，它常表现为晚期疾病且预后不良。
