前列腺恶性间叶性软骨肉瘤1例并文献复习

发布时间：2018-12-06 08:00

【摘要】：目的分析前列腺恶性间叶性软骨肉瘤的诊疗特点。方法回顾性分析1例前列腺恶性间叶性软骨肉瘤患者的临床资料,并结合文献分析其临床表现、影像学检查、病理特点、治疗及预后。结果患者男,59岁。因尿频、进行性排尿困难于外院诊断为前列腺增生,行经尿道前列腺电切术治疗,术后病理示前列腺恶性间叶性肿瘤。B超检查示膀胱内中等回声团块,未见明显移动,前列腺显示不清,右侧盆腔内可见囊性混合型结构。全身骨扫描检查未见明确骨转移征象。前列腺MRI检查示盆腔内近盆底区可见多发结节状、团块状软组织信号影,较大者位于膀胱右侧。患者于全麻下行根治性膀胱切除术+盆腔淋巴结清扫术+双侧输尿管皮肤造口术,术后病理检查可见片状未分化的原始间叶细胞,其间散在小岛状高分化的软骨细胞,软骨细胞有轻度异型性。免疫组化:波形蛋白和软骨区域胞核S-100均阳性,未分化细胞区域S-100、平滑肌肌动蛋白、CD34、细胞角蛋白CK7、CK8均为阴性。病理诊断为前列腺恶性间叶性软骨肉瘤。患者术后拒绝接受化疗和其他进一步治疗,于术后3个月死亡。结论前列腺恶性间叶性软骨肉瘤患者临床表现以尿频、进行性排尿困难为主,需根据患者的临床表现、影像学检查、组织病理学与免疫组化等综合诊断,治疗首选手术根治切除,术后应针对性给予放疗或化疗。
[Abstract]:Objective to analyze the diagnosis and treatment of malignant mesenchymal chondrosarcoma of prostate. Methods A case of malignant mesenchymal chondrosarcoma of the prostate was retrospectively analyzed. The clinical manifestations, imaging findings, pathological features, treatment and prognosis were analyzed. Results the patient was 59 years old. Because of frequent urination, progressive urination is difficult to diagnose prostatic hyperplasia in external hospital. Transurethral resection of the prostate (TURP) is performed. Postoperative pathology shows malignant mesenchymal neoplasms of the prostate. B ultrasonic examination shows medium echogenic mass in the bladder without obvious movement. The prostate was indistinct and the cystic mixed structure could be seen in the right pelvic cavity. Systemic bone scan showed no clear signs of bone metastasis. MRI examination of the prostate showed that there were multiple nodules and mass soft tissue signals in the pelvic area near the pelvic floor, while the larger ones were located on the right side of the bladder. The patients underwent radical cystectomy and pelvic lymph node dissection under general anesthesia. The pathological examination showed the undifferentiated primitive mesenchymal cells, which were scattered in the islet shaped and highly differentiated chondrocytes. Chondrocytes have mild heterogeneity. Immunohistochemical staining: vimentin and chondrocyte nucleus S-100 positive, undifferentiated cell region S-100, smooth muscle actin, CD34, cell keratin CK7,CK8 were negative. The pathological diagnosis was malignant mesenchymal chondrosarcoma of prostate. The patient refused chemotherapy and other further treatment and died 3 months after the operation. Conclusion the main clinical manifestations of malignant mesenchymal chondrosarcoma of prostate are frequent urination and progressive dysuria. It is necessary to make a comprehensive diagnosis according to the clinical manifestation, imaging examination, histopathology and immunohistochemical examination of prostatic malignant mesenchymal chondrosarcoma. Radical resection is the first choice, and radiotherapy or chemotherapy should be given after operation.
【作者单位】：天津医科大学第二医院天津市泌尿外科研究所;
【基金】：天津市科技计划项目(11ZCGYSY02300)
【分类号】：R737.25

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