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Title: 聴神経障害で発症した前立腺小細胞癌の1例
Other Titles: Prostatic carcinoma that arose with hearing loss: a case report
Authors: 佐久間, 貴彦  KAKEN_name
吉田, 栄宏  KAKEN_name
大橋, 寛嗣  KAKEN_name
西村, 健作  KAKEN_name
川野, 潔  KAKEN_name
Author's alias: Sakuma, Takahiko
Yoshida, Takahiro
Ohashi, Hiroshi
Nishimura, Kensaku
Kawano, Kiyoshi
Keywords: Androgen receptor
Metastasis
Prostate
PSA
Small cell carcinoma
Issue Date: Jun-2007
Publisher: 泌尿器科紀要刊行会
Journal title: 泌尿器科紀要
Volume: 53
Issue: 6
Start page: 413
End page: 416
Abstract: 69歳男。左耳鳴り, 回転性眩暈, 左難聴を主訴とした。左頸部にリンパ節を多数触知し, 頭部CT・MRI所見にて左耳下腺周囲, 深頸部, 左鎖骨下に多発性のリンパ節腫脹を認めた。頸部リンパ節生検にて小細胞癌と診断し, 全身検索を行った。胸腹部CT・MRI所見にて骨盤内の多数の結節及び性嚢・膀胱後壁浸潤を伴う前立腺腫大を認め, 前立腺癌を疑った。経会陰的前立腺針生検, 神経内分泌マーカーの発現, 血清NSE値の上昇などより小細胞癌であったが, AR陽性, 血清PSA高値であり, 腺癌の性質も示した。leuprorelin・bicalutamideからなるMAB療法を行ったところ, 難聴の改善, 頸部リンパ節の縮小を認め, 一時的に血清PSA・血清NSE値が低下した。その後, MBA療法をleuprorelin・flutamideに変更し, 現在はdocetaxel・estramustine療法にて胆癌生存中であるが, PSA値の再上昇を認める。
A 69-year-old male with tinnitus, vertigo, and progressive hearing loss of left ear was admitted to our hospital. Head magnetic resonance imaging and computed tomography (CT) revealed swelling of multiple neck lymph nodes (LNs) invading the skull base, which involved left mastoid sinus/the eighth cranial nerve. Biopsy of the cervical LN demonstrated small-cell carcinoma (SCC). Whole body CT showed systemic lymphadenopathies (subclavian, para-aortic, and bilateral iliac LNs) and prostatic swelling with multiple pelvic masses. Needle biopsy of the prostate revealed SCC (Gleason score: 5+ 5). Immunohistochemically, neuron-specific enolase (NSE) and NCAM were detected in <10% and -100% of cancer cells, respectively. Despite SCC histology, prostate-specific antigen (PSA) and androgen receptor (AR) were also expressed in -20% and -70% of tumor cells, respectively. Serum PSA and NSE were 464 ng/ml and 12 ng/ml, respectively. After maximum androgen blockade (MAB) with leuprorelin/bicalutamide, the patient showed recovery of hearing loss, regression of cervical LNs (partial response), and decline of serum markers (PSA 7.38 ng/ml and NSE 3.7 ng/ml, respectively). As re-increase of PSA was observed after ten months, MAB menu was changed to leuprorelin/fultamide. Another four months later, the treatment was changed to docetaxel/ estramustine due to the appearance of systemic bone pain and recurrence of LN metastases. He is alive (39 months after diagnosis) with cancer. Widespread metastases at the time of diagnosis were compatible with SCC. However, this case was AR-positive and responded to androgen ablation, at least temporarily. Even though the initial symptoms are atypical for a prostatic carcinoma, SCC of prostate needs to be included as a rare differential diagnosis.
URI: http://hdl.handle.net/2433/71419
PubMed ID: 17628942
Appears in Collections:Vol.53 No.6

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