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|Other Titles:||Combined small-cell carcinoma/adenocarcinoma of prostate: report of two cases|
|Authors:||佐久間, 貴彦 |
|Author's alias:||Sakuma, Takahiko|
|Abstract:||前立腺小細胞癌の1亜型である小細胞癌/腺癌混合癌の2例を報告した。症例1は76歳男性で, 前立腺特異抗原(PSA):1760ng/ml, NSE:88ng/mlであった。前立腺針生検で, 融合腺管像, 癒合腺房像, 小細胞癌を認めた。Maximum androgen blockade(MAB)療法によりPSAは低下したが, 血清NSE値は上昇し, MAB療法の効果は進行(PD)と判定した。全身状態の悪化のため, 診断後3ヵ月で死亡した。症例2は69歳男性で, PSA:23.1ng/ml, NSE:6.9ng/mlであった。前立腺針生検で, 小細胞癌・腺癌が混在した像を認めた。MAB療法によりPSAは0.192ng/mlまで低下し, MAB療法の効果は著効(CR)と判定した。患者は15ヵ月間, 再発兆候なく生存中である。前立腺小細胞癌/腺癌混合癌は形態から治療に対する反応や予後などを予測するのは困難で, 今後のさらなる検討が必要だと考えられた。|
We report two cases of combined small-cell carcinoma (SCC) and adenocarcinoma of prostate. Case 1 was a 76-year-old man with loss of appetite and body weight and neck lymphadenopathies. Whole body computed tomography (CT) revealed prostatic swelling, pancreatic mass, para-aortic lymphadenopathies, and multiple lung nodules. Elevation of tumor markers (prostate specific antigen [PSA, 1,760 ng/ml] and neuron-specific enolase [NSE, 88 ng/ml]) was noted. Needle biopsy of the prostate demonstrated both SCC and adenocarcinoma. Only within the part of SCC, were neuroendocrine (NE) markers (chromogranin A [CgA], NCAM, and synaptophysin [SNP]) expressed. Maximum androgen blockade (MAB) resulted in a decrease of PSA (5.13 ng/ml) but an increase of NSE (810 ng/ml). Cytotoxic chemotherapy was not possible because of his poor performance state and renal dysfunction. The patient died three months after the diagnosis. Case 2 was a 69-year-old male with dysuria. The symptom and elevated serum PSA (23.1 ng/ml) prompted prostatic needle biopsy, which demonstrated combined SCC/adenocarcinoma. NE markers (CgA and SNP) were weakly expressed in the part of SCC. Serum NSE was 6.9 ng/ml. After MAB, serum PSA dropped to the normal range (0.192 ng/ml) and the effect of MAB was judged as complete response (CR). The patient has been alive for 15 months with no signs of relapse. Treatment of combined SCC and adenocarcinoma of prostate poses a dilemma. In Case 1, MAB was effective for adenocarcinoma but not for SCC. The opposite situation would be expected with systemic chemotherapy. However, the histologically similar Case 2 achieved CR with MAB alone. Much remains to be elucidated to better manage combined SCC/adenocarcinoma of prostate.
|Appears in Collections:||Vol.53 No.7|
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