前列腺癌肉瘤。21例报告。

Carcinosarcoma of the prostate. Report of 21 cases.

作者信息

Dundore P A, Cheville J C, Nascimento A G, Farrow G M, Bostwick D G

机构信息

Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA.

出版信息

Cancer. 1995 Sep 15;76(6):1035-42. doi: 10.1002/1097-0142(19950915)76:6<1035::aid-cncr2820760618>3.0.co;2-8.

DOI:10.1002/1097-0142(19950915)76:6<1035::aid-cncr2820760618>3.0.co;2-8

PMID:8625205

Abstract

BACKGROUND

Carcinosarcoma of the prostate is an unusual malignancy characterized by adenocarcinoma intimately admixed with sarcoma.

METHODS

The authors reviewed the clinical and pathologic findings of 21 cases of carcinosarcoma of the prostate from the files of the Mayo Clinic.

RESULTS

Patient age ranged from 50 to 89 years (mean, 68 years). Ten patients (48%) had a previous diagnosis of prostatic acinar adenocarcinoma 2-73 months (mean, 33 months) before the diagnosis of carcinosarcoma, 8 of whom had received androgen deprivation therapy and/or radiation therapy in the interim. The Gleason score of adenocarcinoma ranged from 7 to 10 (mean, 9; median, 9). The sarcomas consisted of osteosarcoma (13), leiomyosarcoma (5), fibrosarcoma (1), malignant fibrous histiocytoma (1), and rhabdomyosarcoma (1), and the grade of the sarcoma component ranged from 2 to 4 (mean, 4; median, 4). Adenocarcinoma was the dominant histologic pattern in 7 cases and sarcoma in 14. Immunohistochemical staining revealed cytoplasmic reactivity for prostate specific antigen or keratin in 16 of 16 cases in the adenocarcinoma component. The sarcoma component was positive for vimentin in 16 of 16 cases, actin in 8 of 16 (focal in 2), S-100 protein in 2 of 16, and desmin in 1 of 16. At the time of diagnosis of carcinosarcoma, 11 patients had metastases, including 4 with metastatic adenocarcinoma before the diagnosis of carcinosarcoma. Treatment varied, and nonsurgical therapy was ineffective. Sites of metastases included lung (10 cases), bone (7), brain (4), liver (1), and peritoneum (1). Follow-up ranged from 1 to 107 months after the diagnosis of carcinosarcoma (mean, 34 months; median, 10 months). Mean time to tumor progression was 23 months (range, 1-96 months; median, 18 months). Eighteen patients died of carcinosarcoma from 2 to 107 months (mean, 34 months; median, 9.5 months) after diagnosis. Five-year survival was 41%, and 7-year survival was 14%. Progression and survival were not affected by histologic pattern.

CONCLUSIONS

Carcinosarcoma of the prostate is an aggressive malignancy, regardless of histologic type.

摘要

背景

前列腺癌肉瘤是一种罕见的恶性肿瘤，其特征是腺癌与肉瘤紧密混合。

方法

作者回顾了梅奥诊所档案中21例前列腺癌肉瘤的临床和病理结果。

结果

患者年龄在50至89岁之间（平均68岁）。10例患者（48%）在诊断癌肉瘤前2至73个月（平均33个月）曾被诊断为前列腺腺泡腺癌，其中8例在此期间接受了雄激素剥夺治疗和/或放射治疗。腺癌的Gleason评分在7至10分之间（平均9分；中位数9分）。肉瘤包括骨肉瘤（13例）、平滑肌肉瘤（5例）、纤维肉瘤（1例）、恶性纤维组织细胞瘤（1例）和横纹肌肉瘤（1例），肉瘤成分的分级在2至4级之间（平均4级；中位数4级）。7例中腺癌是主要组织学类型，14例中肉瘤是主要组织学类型。免疫组织化学染色显示，腺癌成分的16例中有16例前列腺特异性抗原或角蛋白呈细胞质反应阳性。肉瘤成分的16例中有16例波形蛋白呈阳性，16例中有8例肌动蛋白呈阳性（2例为局灶性阳性），16例中有2例S-100蛋白呈阳性，16例中有1例结蛋白呈阳性。在诊断癌肉瘤时，11例患者有转移，其中4例在诊断癌肉瘤前已有转移性腺癌。治疗方法各不相同，非手术治疗无效。转移部位包括肺（10例）、骨（7例）、脑（4例）、肝（1例）和腹膜（1例）。癌肉瘤诊断后的随访时间为1至107个月（平均34个月；中位数10个月）。肿瘤进展的平均时间为23个月（范围1至96个月；中位数18个月）。18例患者在诊断后2至107个月（平均34个月；中位数9.5个月）死于癌肉瘤。5年生存率为41%，7年生存率为14%。进展和生存不受组织学类型的影响。