攝護腺大細胞神經內分泌瘤之特殊案例報告

廖偉創、張彰琦、陳修聖、莊梓昱

臺北市立聯合醫院忠孝院區外科部泌尿科

De novo large cell neuroendocrine carcinoma of the prostate gland with liver metastasis: a case report

Wei-Chuang Liao, Chang-Chi Chang, Shiou-Sheng Chen, Tzu-Yu Chuang  

Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch

Introduction

Large cell neuroendocrine carcinoma (LCNEC) of the prostate, especially de novo, is an extremely rare histological entity in prostate cancer. Neuroendocrine tumors of the prostate can be described as adenocarcinoma with neuroendocrine differentiation, well-differentiated neuroendocrine tumors, and small or large cell neuroendocrine carcinoma. LCNEC of the prostate is very aggressive and often diagnosed with widespread metastases. We reported a case of a de novo LCNEC of the prostate with liver metastasis diagnosed incidentally in an 85-year-old man who underwent transurethral resection of the prostate (TURP).

Case presentation

An 85-year-old man presented with difficulty in voiding and progressive nocturia for the past one month, which required catheterization due to acute urine retention prior to admission to the hospital. Past medical history included hypertension, dyslipidemia and benign prostate enlargement under medication control. A digital rectal examination indicated that smooth surface, hard consistency and enlarged prostate without palpable nodules. The prostate-specific antigen (PSA) was 0.738 ng/ml. The ultrasound demonstrated intact prostatic capsule, homogenous echogenic appearance and intravesical prostatic protrusion, and overall volume was 54.6 ml. He underwent TURP to manage urinary symptoms. The pathological diagnosis showed pure large cell neuroendocrine carcinoma. A subsequent contrast computed tomography scan (CT scan) with the chest, abdomen and pelvis was performed and revealed multiple poor enhanced lesions on right hepatic lobe which suspected distant metastases. The patient was transferred to oncologist and underwent 6 cycles of neoadjuvant chemotherapy (Docetaxel and cisplatin).

Conclusion

LCNEC of prostate is a rare entity, especially when arising de novo with no prior history of androgen deprivation therapy. Considering the lack of PSA secretion for LCNEC, most cases were diagnosed incidentally at the time of TURP for urinary symptoms relief. Systemic therapy (mostly chemotherapy) remained the mainstay treatment for LCNEC of prostate, but with poor survival outcomes because most cases were found with distant metastasis in initial diagnosis.