粘液産生前立腺癌の2症例

Abstract

第1例(56歳男)は, 1968年に良性前立腺肥大鞘の診断で被膜下前立腺摘出術が行われ, 組織学的に粘液産生癌が発見され, 免疫組織化学的染色上, PAP(前立腺酸性フォスファターゼ)・PSA(前立腺特異抗原)陽性, CEA(癌胎児性抗原)陰性であった.70 Gyの前立腺照射が行われたが, 血清PAPが上昇した1976年に死亡した.剖検で肝, 肺, 骨, 腹膜, 脾, 膵及びリンパ節に転移を認めたが, 原発性消化器系腺癌は認められなかった.第2例(57歳男)は, 1982年に前立腺精上近傍の乳頭状腫瘍に対してTUR(経尿道的切除術)が行われ, 腺腫様ポリープと誤診され, PSA・PAP陰性, CEA陽性であった.前立腺尿道の再発腫瘍に対する3回のTUR後, 前立腺尿道摘出, 骨盤リンパ節郭清, 及び膀胱瘻造設が1985年に行われた.組織学的に粘液産生前立腺癌と診断された.1987年に膀胱後部に腫瘍が再発し, 1990年に死亡した.剖検上, 局所再発の外には転移がなく, 原発性消化器系腺癌は認められなかった

We report two cases of mucinous adenocarcinoma of the prostate. A 56-year-old man underwent subcapsular prostatectomy under the diagnosis of benign prostatic hyperplasia in 1968, and was found to have mucinous adenocarcinoma of the prostate, which proved to be prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) positive, and carcinoembryonic antigen (CEA) negative by immunohistochemical staining. Subsequently he received 70 Gy of irradiation to the prostate, but died in 1976, when serum PAP was elevated. Autopsy revealed metastases to the liver, lungs, bone, peritoneum, spleen, pancreas, lymph nodes, and no primary gastrointestinal adenocarcinoma. The other case was a 57-year-old man, who underwent transurethral resection (TUR) for papillary tumor located just lateral to the verumontanum in 1982. The tumor was misdiagnosed as adenomatous polyp, and was PSA and PAP negative, and CEA positive. After 3 TURs of the recurrent tumor on the prostatic urethra, he underwent prostatourethrectomy, pelvic lymphadenectomy, and cystostomy for radical cure in 1985. The specimen proved to be mucinous adenocarcinoma of the prostate. He suffered recurrence of the tumor in the retrovesical space in 1987, and died in 1990. Autopsy revealed no evidence of metastasis except the local recurrence and no primary gastrointestinal adenocarcinoma.