原发性前列腺印戒细胞癌6例报告及文献复习

Primary prostatic signet ring cell carcinoma: a report of 6 cases and literature review

摘要

目的 探讨原发性前列腺印戒细胞癌（SRCC）的诊断、治疗及预后，为该病的临床诊治提供参考。方法 回顾性分析2020年11月-2024年9月于南京大学医学院附属鼓楼医院经手术治疗的6例原发性前列腺SRCC患者的临床资料，总结其临床表现、影像学特征、治疗方法、组织学特征及肿瘤预后。结果 患者平均（72.00±4.28）岁，4例（患者1、3、4、6）有不同程度排尿困难。所有患者术前均接受多参数磁共振成像（mpMRI）检查，影像表现与典型前列腺癌相似。术前活检均提示高级别（Gleason 8～10分）前列腺腺泡腺癌。术后病理诊断均为前列腺腺泡腺癌与SRCC的混合型，均未发现盆腔淋巴结转移。术后随访1～46个月，所有患者均存活。3例（患者1、3、4）仅行机器人辅助腹腔镜下根治性前列腺切除术（RARP）；2例（患者5、6）术后接受阿帕他胺+亮丙瑞林/曲普瑞林方案治疗；1例（患者2）术后接受比卡鲁胺+戈舍瑞林方案治疗24个月后发现前列腺癌膀胱转移，更换为达罗他胺并联合放疗后患者血清前列腺特异性抗原（PSA）水平降低至安全水平（＜0.2 ng/mL）。其余患者未见复发或转移。结论 原发性前列腺SRCC是一种罕见的高侵袭性前列腺恶性肿瘤，主要根据病理学检查确诊，缺乏特异性影像特征与临床表现，预后较差，目前尚无标准治疗方案。综合应用外科手术、内分泌治疗及放疗有助于提高患者的生存率。

Abstract

Objective To explore the diagnosis, treatment and prognosis of primary prostatic signet ring cell carcinoma (SRCC), so as to provide reference for the clinical diagnosis and treatment. Methods A retrospective analysis was conducted on the clinical data of 6 patients with primary prostatic SRCC treated in Nanjing Drum Tower Hospital during Nov. 2020 and Sep. 2024. The clinical manifestations, imaging features, treatment methods, histological characteristics and prognosis were summarized. Results The average age of the patients was (72.00±4.28) years. Varying degrees of dysuria occurred in 4 patients. All patients underwent multi-parametric magnetic resonance imaging (mpMRI) examination before surgery, and the results indicated typical prostate cancer. Preoperative biopsies showed high-grade (Gleason 8-10) prostate acinar adenocarcinoma. Postoperative pathological diagnoses were mixed types of prostate acinar adenocarcinoma and SRCC, and no metastasis was found in the pelvic lymph nodes. All patients were followed up for 1 to 46 months after surgery and are currently alive. Robot-assisted laparoscopic radical prostatectomy only was performed in 3 cases; apalutamide and leuprolide/triptorelin was administered after surgery in 2 cases; bicalutamide + goserelin was administered after surgery in 1 case, who developed bladder metastasis of prostate cancer 24 months later, and the serum prostate-specific antigen (PSA) concentration decreased to a safe level (<0.2 ng/mL) after the use of darolutamide with radiotherapy. No recurrence or metastasis was found in the remaining patients. Conclusion Primary prostatic SRCC is a rare and highly aggressive malignant tumor of the prostate. The diagnosis depends on pathological examinations due to lack of specific imaging features and clinical manifestations. The prognosis is poor, and there is currently no standardized treatment. The combined use of surgery, hormonotherapy and radiotherapy can help improve the survival rate of patients.

关键词

前列腺肿瘤 / 印戒细胞癌 / 免疫组织化学 / 根治性前列腺切除术

Key words

prostatic neoplasm / signet ring cell carcinoma / immunohistochemistry / radical prostatectomy

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基金资助

国家自然科学基金委员会中德合作交流项目(M-0670)

江苏省自然科学基金项目(BE2020622)