Zhang Baolin, Zhu Yifan, Huang Renpeng, Zhou Feng, Ling Zhixin
Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Department of Pathology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Front Oncol. 2025 Jul 7;15:1617699. doi: 10.3389/fonc.2025.1617699. eCollection 2025.
Large cell neuroendocrine carcinoma of the prostate is an extremely rare malignant subgroup with limited reported cases. Little is known about its pathological characteristics, treatment options and long-term prognosis. In this case, we report a young patient presenting with painless gross hematuria for 3 months, accompanied with elevated serum total prostate-specific antigen (tPSA) level of 83.7 ng/ml. Magnetic resonance imaging (MRI) and 18F-FDG Positron Emission Tomography - Computed Tomography (¹F-FDG PET/CT) indicated giant prostate mass, which metastasized to bilateral lungs, bones and lymph nodes. Prostate biopsy and transurethral resection of the prostate confirmed the diagnosis of adenocarcinoma with a Gleason score of 4 + 5. After receiving 12 months of goserelin acetate, rezvilutamide and six cycles of docetaxel, the patient further underwent laparoscopic radical prostatectomy (LRP). Immunohistochemical analysis (Syn+/CgA+/AR-) combined with treatment history revealed a histopathological diagnosis of treatment-related LCNEPC. Subsequently, the patient then received immunotherapy with serplulimab (300 mg) and the EP regimen (combining etoposide and cisplatin) chemotherapy. After six cycles of chemo-immunotherapy, further examination indicated reduction in size of multiple lymph nodes and lung metastases by March 2025. Here we reported a rare case of treatment-related LCNEPC, who had experienced systematic therapy with comprehensive care. These diagnostic and therapeutic approaches may improve the management capability and highlight the critical role of multimodal strategies in the subsequent cases.
前列腺大细胞神经内分泌癌是一种极其罕见的恶性亚组，报告的病例有限。对其病理特征、治疗选择和长期预后知之甚少。在本病例中，我们报告了一名年轻患者，出现无痛肉眼血尿3个月，血清总前列腺特异性抗原（tPSA）水平升高至83.7 ng/ml。磁共振成像（MRI）和18F-FDG正电子发射断层扫描-计算机断层扫描（¹F-FDG PET/CT）显示巨大前列腺肿块，已转移至双侧肺、骨骼和淋巴结。前列腺活检和经尿道前列腺切除术确诊为腺癌，Gleason评分为4+5。在接受12个月的醋酸戈舍瑞林、瑞维鲁胺和六个周期的多西他赛后，患者进一步接受了腹腔镜前列腺癌根治术（LRP）。免疫组织化学分析（Syn+/CgA+/AR-）结合治疗史显示为治疗相关的大细胞神经内分泌前列腺癌（LCNEPC）的组织病理学诊断。随后，患者接受了替雷利珠单抗（300 mg）免疫治疗和EP方案（依托泊苷和顺铂联合）化疗。经过六个周期的化疗免疫治疗后，进一步检查显示，到2025年3月，多个淋巴结和肺转移灶的大小有所缩小。我们在此报告了一例罕见的治疗相关LCNEPC病例，该患者接受了系统治疗并得到了全面护理。这些诊断和治疗方法可能会提高管理能力，并突出多模式策略在后续病例中的关键作用。
