前列腺透明細胞腺癌-案例報告
陳子双1、宋明澤2、鄭元佐1
1高雄長庚紀念醫院 泌尿科，2病理部
Clear cell adenocarcinoma of the prostate ─ A Case Report
Tzu-Shuang Chen1, Ming-Tse Sung2, Yuan-Tso Cheng1
Department of Urology1 and Pathology2, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Purpose: Clear cell adenocarcinoma occurring in the prostate is an extremely unusual malignant tumor with diagnostic challenge and with various possible diagnoses. We report a case of clear cell adenocarcinoma of the prostate with right renal hilum and periarotic lymph node metastasis.
Case presentation: A 44-year old man suffered from persistent dysuria and frequency for months accompanied with low abdomen pain and scrotum swelling with redness. Urine routine examination revealed pyuria and hematuria. Digital rectal exam found an enlargement of prostate, so prostate abscess was first impressed. After transurethral resection of the prostate, the specimen showed a picture of clear cell adenocarcinoma, composed of solid, papillary, and tubulocystic structure lined by cuboidal and focal hobnail cells with clear to eosinophilic cytoplasm. In the immunohistochemical(IHC) stained study, the tumor cells show positive for PAX8 but negative for PSA and p63. Therefore, the final diagnosis is clear cell carcinoma of the prostate. His MRI image revealed mass lesion beneath the urinary bladder and invasion to seminal vesical with unknown origin. Suspicious metastatic lymphadenopathy over right renal hilum and periaortic area were also noticed. This is an unique feature different from classic prostate cancer, which are mostly metastatic to pelvic lymph nodes.
Conclusions: Clear cell adenocarcinoma of the prostate is extremely rare. To make a correct diagnosis, histology, imaging studies, serum PSA levels, and IHC stain are necessary. Further studies such as PD-L1, MSI, and whole genome gene aberrations analysis are required to best approach appropriate treatment of this unique cancer.