Pure prostatic papillary adenocarcinoma with ductal features

Abstract

67歳男性.排尿障害・残尿感を主訴に近医を受診, PSA高値にて著者らの施設へ紹介となった.初診時のPSA 22.6ng/mlであったが, 前立腺炎の治療を行い症状は改善, PSAも低下した.しかし, 約2年間に7.3ng/mlから9.9ng/mlの間を推移, その後は11.9ng/mlまで上昇した.MRI・経直腸超音波にて前立腺右葉に4.5×3×3.5cmほどの腫瘤を認め, 前立腺針生検で乳頭状前立腺癌が疑われた.リンパ節腫脹・遠隔転移は認められぬものの, 前立腺全摘術を施行した結果, 病理組織学的に導管型の前立腺癌と診断された

Papillary adenocarcinoma resembling ductal carcinoma and arising in the peripheral zone is extremely rare. We report a case of prostatic papillary adenocarcinoma with ductal features. The patient was a 68-year-old man who initially presented with dysuria and sensation of residual urine after voiding. Prostatic needle biopsy findings supported pathological diagnosis of prostatitis. The symptoms were improved by medication for prostatitis, and prostate-specific antigen (PSA) level of 22.6 ng/ml descreased to 9.9 ng/ml. It remained between 7.2 ng/ml and 9.9 ng/ml for 2 years. However, it gradually increased to 11.9 ng/ml. Transrectal digital examination, T2-weighted magnetic resonance imaging (MRI) of the prostate and transrecral ultrasound showed a mass in the enlarged right side of the prostate. Transrectal needle biopsy of the mass was performed, and papillary adenocarcinoma was suspected by histological examination. Radical prostatectomy was performed. Histological and immunohistochemical examination of the prostatectomy specimen revealed pure prostatic papillary adenocarcinoma with ductal features.