攝護腺之Basaloid Cell Carcinoma案例報告及文獻回顧
顧明軒1、黃志賢1、2、3、林登龍1、2、3、陳光國1、2、3
臺北榮民總醫院 泌尿部1；國立陽明大學醫學院泌尿學科2；書田泌尿科學研究中心3
A case report of basaloid carcinoma of the prostate and literature review
Ming-Hsuan Ku1, William J.S. Huang 1,2,3, Alex T.L. Lin 1,2,3, Kuang-Kuo Chen 1,2,3
Department of Urology, Taipei Veterans General Hospital 1,
Department of Urology 2, School of Medicine and Shu-Tien Urological Science Research Center 3,
National Yang-Ming University, Taipei, Taiwan
Case Presentation:
A 68-year-old male patient was found with elevated PSA level of 8.9 ng/ml during health examination. He came to our department for further work-up. A digital rectal examination disclosed smooth surface of the prostate, rubbery in consistency with no hard nodular lesions. 1st prostate biopsy reported right side focal chronic inflammation and left side benign hyperplasia. Three months later, PSA level increased to 12.22 ng/ml with free form 14.6%. 2nd prostate biopsy reported atypical cells over bilateral lobes of the prostate, suspicous for carcinoma but not mimic conventional prostate adenocarcinoma. We sent the pathologic slides to Johns Hopkins Hospital for further work-up. Consultation report replied the pathologic features were highly favored basaloid cell carcinoma, but could not absolutely exclude a peculiar adenocarcinoma. After discussed in our combined meeting, 3rd time of prostate biopsy was done and adenocarcinoma, Gleason grade 4+3, was found in one biopsy core. Open radical prostatectomy was further performed. Final pathology report was basaloid cell carcinoma. The patient was followed up at our department for another 8 years with no evidence of disease recurrence or distant metastases. The latest PSA level remained undectable.
Literature Review:
Adenocarcinoma accounts for the majority of prostate cancer. However, there are still some variants present such as basaloid cell carcinoma, which has distinct histopathologic features and clinical characteristics.
Basaloid cell carcinoma of the prostate is a neoplasm composed of basal cells of the prostate. Basal cells of the prostate have no secretory function, so serum PSA of basaloid cell carcinoma may be within normal range. Patients with basaloid cell carcinoma accompanied with elevated preoperative PSA level are usually diagnosed with concurrent prostate cancer.
Diagnosis of basaloid cell carcionoma relies on the pathological findings. On immunohistochemistry, tumor cells of the basaloid cell carcinoma may be positive for immunostaining of p63 and cytokeratin 34bE12. Conventional adenocarcinoma of the prostate is negative for binding of these antibodies.
Basaloid cell carcinoma of the prostate was regarded as a relatively indolent tumor. However, there were still some case reports presented cases with aggressive behavior. Radical prostatectomy was the most recommended treatment. Chemotherapy may be helpful but with only few reports. Hormone therapy was still controversial at present due to the scarcity of reported cases.