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目的探讨原发性前列腺黏液腺癌的临床病理特征、诊断与鉴别诊断。方法分析3例原发性前列腺黏液腺癌的临床表现、病理形态学特征、免疫组化及组织化学染色特点,并复习相关文献。结果 3例患者临床表现均为排尿困难或膀胱刺激症状,2例血PSA升高,1例正常。大体前列腺切面呈海绵状,2例见胶冻样结节,1例未见明确结节。镜下肿瘤组织主要由蓝染的黏液湖及少量异型上皮细胞团组成,上皮细胞巢呈筛状、腺管状或实性团状漂浮于黏液湖中;3例均合并少量经典型前列腺腺泡癌成分。免疫组化:瘤细胞PSA、CK7和CK19均弥漫强(+),CK20灶性(+),CA125、CEA和CDX-2(-)。AB/PAS染色显示黏液主要位于细胞外,极少数细胞可见细胞内黏液。术后给予化疗或放疗,随访时间分别为6、46个月及10年,未见复发及转移。结论原发性前列腺黏液腺癌是前列腺癌中少见的组织学亚型,确诊时需要与转移性黏液腺癌鉴别,免疫组化可以协助诊断。
Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of primary prostatic mucinous adenocarcinoma. Methods Three cases of primary mucinous adenocarcinoma of the prostate were analyzed for clinical manifestations, histopathological features, immunohistochemical and histochemical staining, and reviewed the relevant literature. Results The clinical manifestations of 3 patients were all dysuria or bladder irritation, 2 cases of elevated serum PSA and 1 case of normal. General prostate section was sponge, 2 cases of jelly-like nodules, 1 case no clear nodules. The microscopic tumor mainly consisted of blue-stained mucous lake and a small amount of atypical epithelial cell mass. The epithelial cell nests were in the shape of sieve, glandular or solid mass floating in mucous lake. All three cases combined with a small amount of classic prostatic adenocarcinoma ingredient. Immunohistochemistry: The tumor cells PSA, CK7 and CK19 were diffusely strong (+), CK20 focal (+), CA125, CEA and CDX-2 (-). AB / PAS staining showed mucus mainly in the extracellular, very few cells visible intracellular mucus. After chemotherapy or radiotherapy, the follow-up time was 6,46 months and 10 years respectively. No recurrence or metastasis was found. Conclusions Primary prostatic mucinous adenocarcinoma is a rare histological subtype in prostate cancer. It needs to be differentiated from metastatic mucinous adenocarcinoma when diagnosed, and immunohistochemistry can help diagnose.