Benabdallah Wajdi, Ben Othmane Mouna, Ouahchi Ines, Mestiri Sarra, Belkacem Oussama, Bouassida Khaireddine, Hmida Wissem, Jaidane Mehdi
Urology Department.
Department of Cytogenetic and Reproductive Biology, Farhat Hached University Teaching Hospital, Sousse, Tunisia.
Ann Med Surg (Lond). 2023 Apr 11;85(5):1888-1893. doi: 10.1097/MS9.0000000000000373. eCollection 2023 May.
The extragastrointestinal stromal tumor (EGIST) is defined as a mesenchymal neoplasm arising from soft tissues outside the gastrointestinal tract, and the prostate is a rare presentation site.
A 58-year-old man was presented with lower urinary tract symptoms for 6 months. A digital rectal examination revealed a markedly enlarged prostate with a smooth, bulging surface. Prostate-specific antigen density was 0.5 ng/ml. MRI of the prostate showed an enlarged prostatic mass with hemorrhagic necrosis. Transrectal ultrasound-guided prostate biopsy was performed and pathological reports suggested a gastrointestinal stromal tumor. The patient refused radical prostatectomy and received only imatinib treatment.
The diagnosis of EGIST of the prostate is extremely rare and depends on the histopathologic features with immunohistochemical results. The treatment is essentially based on radical prostatectomy, but there are other therapeutic modalities associating surgery with adjuvant or neoadjuvant chemotherapy. For patients refusing surgery, treatment with imatinib alone appears to be a therapeutic solution.
Despite the rarity, EGIST of the prostate should be included in the differential diagnosis of patients presenting with lower urinary tract symptoms. There is no consensus regarding the treatment of EGIST, and the patients are treated as per the risk stratification.
胃肠道外间质瘤(EGIST)被定义为起源于胃肠道外软组织的间叶性肿瘤,而前列腺是一种罕见的发病部位。
一名58岁男性出现下尿路症状6个月。直肠指检发现前列腺明显增大,表面光滑、隆起。前列腺特异性抗原密度为0.5 ng/ml。前列腺MRI显示前列腺肿块增大伴出血性坏死。进行了经直肠超声引导下前列腺活检,病理报告提示为胃肠道间质瘤。患者拒绝根治性前列腺切除术,仅接受伊马替尼治疗。
前列腺EGIST的诊断极为罕见,取决于组织病理学特征及免疫组化结果。治疗主要基于根治性前列腺切除术,但也有其他治疗方式将手术与辅助或新辅助化疗相结合。对于拒绝手术的患者,单独使用伊马替尼治疗似乎是一种治疗方案。
尽管罕见,但前列腺EGIST应纳入出现下尿路症状患者的鉴别诊断中。关于EGIST的治疗尚无共识,患者根据风险分层进行治疗。