De novo large cell neuroendocrine carcinoma of the prostate gland with pelvic lymph node metastasis: a case report with review of literature (original) (raw)
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Large Cell Neuroendocrine Carcinoma of Prostate
The American Journal of Surgical Pathology, 2006
Neuroendocrine (NE) differentiation in prostate cancer is typically detected by immunohistochemistry as single cells in conventional adenocarcinoma. Prostatic NE tumors, such as carcinoid or small cell carcinoma, are rare and large cell NE carcinoma (LCNEC) is described only in case reports. We identified 7 cases of LCNEC and compiled their clinicopathologic characteristics. In 6 cases, there was a history of adenocarcinoma treated with hormone therapy for a mean of 2.4 years (range: 2 to 3 y). The remaining case was de novo LCNEC. LCNEC was incidentally diagnosed in palliative transurethral resection specimens in 5 cases. The mean patient age at diagnosis with LCNEC was 67 years (range: 43 to 81 y). LCNEC comprised solid sheets and ribbons of cells with abundant pale to amphophilic cytoplasm, large nuclei with coarse chromatin and prominent nucleoli along with brisk mitotic activity and foci of necrosis. In 6 cases, there were foci of admixed adenocarcinoma, 4 of which showed hormone therapy effects. LCNEC was strongly positive for CD56, CD57, chromogranin A, synaptophysin, and P504S/alpha methylacyl CoA racemase. There was strong bcl-2 overexpression, expression of MIB1, and p53 in >50% of nuclei, focally positive staining for prostate specific antigen and prostatic acid phosphatase and negative androgen receptor staining. Followup was available for 6 patients, all of who died with metastatic disease at mean of 7 months (range: 3 to 12 mo) after platinumbased chemotherapy. LCNEC of prostate is a distinct clinicopathologic entity that typically manifests after long-term hormonal therapy for prostatic adenocarcinoma and likely arises through clonal progression under the selection pressure of therapy.
Neuroendocrine Tumors of the Prostate
Cambridge University Press eBooks, 2017
Prostate cancer, with an estimated 233,000 new cases and 29,480 deaths in 2014, is the most common malignancy among men in the United States and only second to lung cancer as the cause of cancerrelated deaths (CA Cancer J Clin 2014;64:9Y29). While conventional (acinar) adenocarcinoma constitutes the vast majority of prostate cancers, rare variants including neuroendocrine tumors have been recognized by the World Health Organization (World Health Organization Classification of Tumours; Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. Lyon, France: IARC Press; 2004) and the American Joint Commission on Cancer (The AJCC Staging Manual. 7th ed. New York: Springer; 2007). Statistically speaking, when an unusual histologic pattern is encountered, one should always consider the possibility of direct extension from adjacent organs and/or metastasis from distant sites. In this article, a brief presentation of 2 cases is followed by an overall review of the spectrum of neuroendocrine tumors of the prostate.
2020
The interest regarding neuroendocrine prostate cancer has widened in the last few years as many of these cases were seen coinciding with the accelerated utilization of androgen deprivation therapy, and thus the possible association between androgen deprivation therapy and neuroendocrine prostate cancer was hypothesized. Even though, androgen deprivation therapy is considered to be the main culprit associated with neuroendocrine prostate cancer, there have been few rare cases that had no prior history of androgen deprivation therapy use in their past. We report here an unusual presentation of de novo case of prostate adenocarcinoma with diffuse neuroendocrine differentiation. An elderly male of 59-year-old presented to our clinic with an enlarged lymph node on left side of neck. Physical examination showed soft abdomen and no visceromegaly, spine was non tender. An excisional biopsy of the lymph node was sent for histopathological examination depicting diffuse effacement of the lymph node architecture by a metastatic tumor comprised of cribriform glands. Immunohistochemical markers were applied to delineate the primary site which showed that the tumor was negative for CK7 and CK20, however prostate specific antigen and prostatic specific acid phosphatase displayed diffuse positivity. In addition, since many cells showed nuclear molding therefore synapophysin and chromgranin were also applied and both of them displayed extensive granular cytoplasmic positivity. Based on these findings a final diagnosis of metastatic prostatic adenocarcinoma with diffuse neuroendocrine differentiation was rendered. Later on, Trans rectal ultrasonography biopsy was performed from all six lobes which showed Grade 5 (Gleason score 4+5) tumor in five out of 6 cores. These tumor cells also displayed strong cytoplasmic staining for synaptophysin and chromogranin highlighting their neuroendocrine differentiation. Only few such cases have been reported in literature and information regarding its clinicopathological features and disease outcome are limited. Our case was a challenging and insightful to add to the literature regarding this rare presentation of prostate cancer.
A pure primary low-grade neuroendocrine carcinoma (carcinoid tumor) of the prostate
International Urology and Nephrology, 2010
The first time in Scandinavia we present a case report of a pure primary low-grade neuroendocrine carcinoma (carcinoid tumor) of the prostate. Our patient is a 34-year-old male with a long history of symptomatic chronic prostatitis/prostatodynia. After developing severe obstructive uropathy, a transurethral resection was performed. An unexpected diagnosis of a low-grade neuroendocrine carcinoma was made. Subsequently, in radical prostatovesiculectomy, we noted metastases to both seminal vesicles and two inguinal lymph nodes. Follow up is ongoing.
Primary and Pure Neuroendocrine Tumor of the Prostate
European Urology, 2004
Primary neuroendocrine tumors of the prostate are very rare and their biologic behaviour is not yet well known. Clinical and histopathologic features of two cases, one with lymph-node involvement and one organ-confined are described. Young age, clinical presentation and good outcome after radical retropubic prostatectomy were comparable in both patients.
International braz j urol, 2011
Purpose: Neuroendocrine carcinomas (NEC) of the prostate are rare, with only a few series hitherto reported. The objective of this study was to assess in a single institution the clinical and morphologic characteristics of neuroendocrine carcinomas diagnosed in needle core biopsies. Materials and Methods: The current study analyses seven cases diagnosed in needle biopsies at a large tertiary regional cancer center from Northeastern Brazil. Two pathologists reviewed specimens retrospectively, and demographic and morphologic characteristics were compared to 458 acinar tumors diagnosed in the same period. Results: There were five small cell carcinomas and two low-grade neuroendocrine carcinomas (carcinoid). NEC were associated with an acinar component in 5/7 cases and the Gleason score of the acinar component was always > 6. The number of cores involved in prostates with NEC was greater (65% compared to 24% of acinar tumors, p < 0.05). The mean PSA at diagnosis was 417.7 (range 5.7-1593, SD 218.3), compared to 100.5 (p = 0.1) of acinar tumors (range 0.3-8545, SD 22.7). Prostates harboring NEC were bigger (p < 0.001, mean volume 240 mL vs. 53 mL of acinar tumors). Treatment of NEC included palliative surgery, chemotherapy, and hormonal therapy. Conclusions: NEC of the prostate is rare and often associated with a high-grade acinar component. Prostates with NEC tend to be larger and involve a greater number of cores than acinar tumors. PSA at diagnosis does not seem to predict the presence of NE tumors in needle biopsy.
Large Cell Neuroendocrine Carcinoma of the Urinary Bladder: Case Report and Review
Current Urology, 2014
Large cell neuroendocrine tumor of the urinary bladder is very rare. It is a type of neuroendocrine carcinoma that is morphologically diff erent from small cell carcinoma. Th is manuscript describes a 67-year-old man who presented with hematuria. Ultrasonogrophic and computer tomography revealed a 5 cm mass in right posterolateral wall of the bladder that invaded perivesical tissue and he subsequently underwent transurethral resection. Microscopic examination showed a tumor with a sheet-like and trabecular growth pattern comprising necrotic areas which infiltrated the muscularis propria. Tumoral cells had coarse chromatin, prominent nucleoli, moderate amount of cytoplasm and immunohistochemically stained strongly positive with synaptophysin, chromogranin and CD56. Th ere are only few case reports of large cell neuroendocrine tumor of the urinary bladder so the biological behavior and the treatment protocol of these tumors are still obscure. Appropriate management protocols and prognostic estimation could be achived by the increased number of cases being reported. Th erefore in a case of a poorly diff erentiated tumor in bladder, although rare, it is important to consider large cell neuroendocrine carcinoma in diff erential diagnosis.
Prostate cancer with neuroendocrine differentiation--case report
Journal of Medicine and Life, 2012
About 95% of prostate cancers are adenocarcinoamas. Depending on the detection method used, neuroendocrine cells are found in 10% to 100% of prostate cancer specimens. A 64-year-old patient was diagnosed in 2006 with adenocarcinoma of the prostate, PSA 4.1 ng/ml, Gleason 6, T3b, positive PSA immunohistochemistry. The patient was started on hormone therapy: orchidectomy followed by flutamide 750 mg/day for three years, and underwent radiotherapy 6400 R. The patient was asymptomatic for three years. In 2009, the patient complained of perineal and rectal pain, but the PSA remained normal. In 2010, the patient underwent TUR of the prostate for acute urinary retention. Pathological exam revealed Gleason 8 adenocarcinoma of the prostate (different pathologist suggested Gleason 9) and foci of neuroendocrine cells. Immunohistochemistry detected 15-20% positivity for Cromogranin A and 10% for synaptophysin. The patient developed multiple liver metastases in October 2010 and underwent five cy...