前立腺乳頭状腺癌の4例

Abstract

前立腺乳頭状腺癌の4例を経験した.症例1は47歳.米国在住中に前立腺癌で前立腺摘出術を受け, 乳頭状腺癌であった.帰国後受診し多発性骨転移, 肺転移を認め, ホスフェストロール投与で消失したが, 左精巣腫大を認め両側精巣摘除術を施行し, 前立腺癌の左精巣転移であった.症例2は72歳.肉眼的血尿で受診し, 尿道鏡で広基性乳頭状腫瘍を認め, TURを施行し乳頭状腺癌であった.本人希望で経過観察中に精丘付近の尿道に再発を認め, フルタミド内服, 酢酸ゴセレリン注射で症状は改善した.症例3は72歳.前立腺肥大症で内服治療中, 尿道鏡で前立腺部尿道に乳頭状隆起を認め, 前立腺全摘術を施行し, 中分化腺癌と乳頭状腺癌の混在であった.症例4は64歳.尿勢不良で受診し, 直腸診で前立腺左様に突出を認め, 針生検を行い高分化腺癌の診断で前立腺全摘術を施行し, 高分化腺癌と乳頭状腺癌の混在であった

Papillary adenocarcinoma of the prostate, previously referred to as endometrioid carcinoma, is a variant of prostatic adenocarcinoma. Clinical and pathological evidence of involvement of the periurethral prostatic duct or verumontanum is usually required for definitive diagnosis of papillary adenocarcinoma. However, significant histologic and clinical features of papillary adenocarcinoma overlap with typical acinar carcinoma. Four cases of papillary adenocarcinoma were studied for the clinical features, histologic characteristics and immunohistochemical nature of prostatic specific antigen. In two cases, there were papillary regions, near the verumontanum, but in the other two cases, there were no papillary regions in the urethra. In two cases, acinar adenocarcinoma coexisted with papillary adenocarcinoma. All cases displayed positive immunohistochemical staining for prostatic specific antigen. In accordance with the observations of others, we suggest that papillary adenocarcinoma is one aspect of growth pattern of acinar adenocarcinoma, not a concept of a unique clinical and pathological entity.