Prostatic sarcoma with rapid tumor progression after nerve sparing radical cystoprostatectomy.
Prostatic sarcoma with rapid tumor progression after nerve sparing radical cystoprostatectomy.
复制标题
保留神经的根治性膀胱前列腺切除术后前列腺肉瘤肿瘤进展迅速。
DOI：
10.1016/s0022-5347(05)65888-0
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
C. Robertson
中科院分区：
文献类型：
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作者：
M. D. Young;P. Dahm;C. Robertson
前列腺肉瘤极为罕见，仅占所有前列腺肿瘤的0.1%至0.2%。然而，在本病例中出现排尿障碍症状是常见的。平滑肌肉瘤和纤维肉瘤是成人最常见的两种病理类型。3定义的组织病理学标准包括梭形细胞增生（图2，A），高细胞性，浸润性生长模式伴坏死区域，以及本病例中明显可见的大量有丝分裂象（图2，B）。前列腺肉瘤是一种侵袭性恶性肿瘤，对治疗提出了重大挑战。据报道，中位生存期从诊断开始不到15个月，只有10%的机会存活超过3年。1,3在很大程度上由于这种肿瘤的罕见发生，没有新辅助或辅助治疗方案被证实有益，而完全根治性手术切除仍然是最可能导致长期生存的首选治疗方法。由于高级别前列腺肉瘤预后恶劣，生活质量问题非常重要。Quinlan等人报道了一名前列腺肉瘤患者在部分膀胱切除术和保留神经技术后的长期生存以及成功保存效力和尿失禁。3类似的考虑促使我们对患者行单侧保神经膀胱切除术和尿转移术。尽管手术成功，切缘阴性，但局部和远处复发发展迅速，最有可能继发于未被识别的微转移性疾病。我们的病例证明了效能保留技术的可行性和高级别前列腺肉瘤的难治性。
DISCUSSIONSarcomas of the prostate are extremely rare, constituting only 0.1% to 0.2% of all prostatic neoplasms. However, presentation with obstructive voiding symptoms as in our case is common. 1, 2 Leiomyosarcoma and fibrosarcoma represent the 2 most common pathological types in adults. 3 Defining histopathological criteria include spindle cell proliferation (fig. 2, A), high cellularity, infiltrative growth pattern with areas of necrosis, and large numbers of mitotic figures as prominently seen in our case (fig. 2, B). Prostate sarcomas can be aggressive malignancies and present a significant therapeutic challenge. Reported median survival is less than 15 months from the time of diagnosis and there is only a 10% chance for survival longer than 3 years. 1, 3 Owing in large part to the rare occurrence of this tumor, no neoadjuvant or adjuvant treatment regimens of proven benefit have been established, while complete radical surgical resection remains the preferred treatment most likely to result in long-term survival. Because of the grim prognosis for high grade prostatic sarcoma, quality of life issues are important. Quinlan et al reported on long-term survival as well as successful preservation of potency and continence following partial cystectomy with a nerve sparing technique in a man with prostatic sarcoma. 3 Similar considerations encouraged us to perform a unilaterally nerve sparing cystectomy and continent urinary diversion on our patient. Despite successful surgery and negative margins, local and distant recurrence developed rapidly and was most likely secondary to unrecognized micrometastatic disease. Our case demonstrates the feasibility of potency preserving techniques and the difficult nature of high grade prostatic sarcoma.