Elhaie Mohammadrzea, Koozari Abolfazl, Khademi Mohammad Reza
Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Iran.
Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Iran.
Radiol Case Rep. 2024 Nov 22;20(2):882-885. doi: 10.1016/j.radcr.2024.10.104. eCollection 2025 Feb.
A 41-year-old male presented with obstructive urinary symptoms and an enlarged prostate. Subsequent testing revealed a remarkably high PSA level of 150 ng/mL, considerably above normal limits, raising concern for possible malignancy. Transrectal ultrasound showed an enlarged heterogeneous prostate measuring 74×80×75mm. PSMA PET/CT detected intense tracer uptake. While MRI and biopsy ruled out carcinoma, they indicated Stromal Tumors of Uncertain Malignant Potential (STUMP), an uncommon diagnosis in younger patients. This complex case highlights the essential role of advanced multimodal imaging and immunohistochemistry in diagnosing atypical prostatic lesions of uncertain malignant potential like STUMP, given their histologic similarity to benign conditions posing diagnostic difficulties. A multidisciplinary approach led to the STUMP diagnosis and decision for long-term monitoring instead of radical prostatectomy due to STUMP's unpredictable behavior. This report reinforces the need for diligence when evaluating seemingly benign but diagnostically challenging presentations that could conceal conditions like STUMP, and the importance of a multidisciplinary approach for accurate diagnosis and management of such rare prostatic proliferations.
一名41岁男性出现梗阻性排尿症状且前列腺增大。随后的检查显示前列腺特异性抗原（PSA）水平显著升高，达150 ng/mL，远高于正常范围，令人担忧可能存在恶性肿瘤。经直肠超声显示前列腺增大，形态不均，大小为74×80×75mm。前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）检测到示踪剂摄取强烈。虽然磁共振成像（MRI）和活检排除了癌，但提示为具有不确定恶性潜能的间质瘤（STUMP），这在年轻患者中是一种罕见的诊断。这个复杂病例凸显了先进的多模态成像和免疫组织化学在诊断像STUMP这样具有不确定恶性潜能的非典型前列腺病变中的重要作用，因为它们在组织学上与良性情况相似，给诊断带来困难。多学科方法导致了STUMP的诊断，并决定进行长期监测而非根治性前列腺切除术，因为STUMP的行为不可预测。本报告强调了在评估看似良性但诊断具有挑战性的表现时需谨慎，这些表现可能掩盖像STUMP这样的情况，以及多学科方法对于准确诊断和管理此类罕见前列腺增生的重要性。
