Lauwers G Y, Schevchuk M, Armenakas N, Reuter V E
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Am J Surg Pathol. 1993 Apr;17(4):342-9. doi: 10.1097/00000478-199304000-00004.
Carcinosarcoma of the prostate is a biphasic tumor containing adenocarcinoma (ACA) and recognizable sarcomatous components. It is a rare neoplasm with only 12 previous reported cases. We describe three additional cases arising between 4 and 6 years after initial diagnosis of prostatic ACA. Two patients were initially treated by prostatectomy, pelvic external beam radiotherapy, and hormonal manipulation. The third patient was treated by pelvic lymphadenectomy and 125I implants. After the development of the sarcomatous component, the first two are still alive with distant metastases and residual pelvic disease at 9 and 17 months. The third patient died with disease 7 months after diagnosis. Histologically, prostatic ACA was recognized in all three cases, as well as a neoplastic mesenchymal component that appeared later. Foci of osteosarcomatous, chondrosarcomatous, and myosarcomatous differentiation were recognized in two of the three cases. Based on the chronologic and the histologic evolution of the neoplasm, we favor sarcomatoid transformation of the ACA as the most likely histogenesis. It appears that radiotherapy and hormonal therapy may be important in the development of at least some of these tumors.
前列腺癌肉瘤是一种双相性肿瘤，包含腺癌（ACA）和可识别的肉瘤成分。它是一种罕见的肿瘤，此前仅有12例报道。我们描述了另外3例在前列腺ACA初次诊断后4至6年出现的病例。2例患者最初接受了前列腺切除术、盆腔外照射放疗和激素治疗。第3例患者接受了盆腔淋巴结清扫术和碘-125植入治疗。在肉瘤成分出现后，前2例患者在9个月和17个月时仍存活，但有远处转移和盆腔残留病灶。第3例患者在诊断后7个月死于疾病。组织学上，3例均识别出前列腺ACA以及后来出现的肿瘤性间叶成分。3例中的2例识别出骨肉瘤、软骨肉瘤和肌肉瘤分化灶。基于肿瘤的时间顺序和组织学演变，我们认为ACA的肉瘤样转化是最可能的组织发生方式。看来放疗和激素治疗可能在至少部分此类肿瘤的发生中起重要作用。
