唐靖 陳忠佐 王彥傑

國泰綜合醫院 外科部 泌尿科

Chin Tang, Chung-Tso Chen, Yen-Chieh Wang

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

 

  We present a case of a 60-year-old male with a medical history of tonsillitis presented to urologic clinic with a chief complaint of frequency and weak-stream urination. He was later diagnosed with prostate enlargement with lower urinary tract symptoms (LUTS) and received transurethral laser enucleation of the prostate at other hospital. Pathology, however, favored carcinosarcoma and he was thus referred to our center for further evaluation. Physical examination was unremarkable. His initial PSA level was 3.54ng/ml at presentation and dropped to 0.74ng/ml after the surgery. All the other lab test and urine analysis were within normal limit. Urological CT showed an heterogenous prostate texture with marked intravesical growth without signs of extracapsular extension or lymphadenopathy. There was also no definite bone metastasis in the whole body bone scan. The patient then received robotic assisted laparoscopic radical prostatectomy (RARP) and a 3.4cm frond-like infiltrative prostatic tumor was surgically excised. The final pathology report revealed a high-grade sarcomatoid urothelial carcinoma of the prostatic urethra, invading the prostate stroma of both lobes with lymphovascular and perineural invasion. The immunochemical stain was positive for CK AE1/3, p63, and GATA 3. His post-operative course was smooth and he was later referred to oncology department for post-operative adjuvant chemotherapy.

  Sarcomatoid variant of urothelial carcinoma is a rare aggressive type of biphasic malignant neoplasms with histological, cytological, or molecular properties of both epithelial tumors and mesenchymal tumors, which tends to present at a younger age and at a higher grade and stage. To the best of my knowledge, no cases of the sarcomatoid urothelial carcinoma of the prostatic urethra have been reported. We present this case to share our experience of diagnosis and management of this peculiar disease.