Prostate Sarcoma
Introduction
Introduction to prostate sarcoma Sarcomaofprostate is rare in clinical practice, including rhabdomyosarcoma, leiomyosarcoma, fibrosarcoma, spindle cell sarcoma, liposarcoma, neurogenic sarcoma, lymphosarcoma, mucinous sarcoma, angiosarcoma, chondrosarcoma, etc. Among them, rhabdomyosarcoma is more common. . basic knowledge Sickness ratio: 0.0001% Susceptible people: male Mode of infection: non-infectious Complications: anemia prostate cancer
Cause
Prostate sarcoma cause
(1) Causes of the disease
Prostate sarcoma originates from the reticular mesoderm, including the terminal part of the Nobel and the Mullerian tube, and can come from the muscular layer of the urogenital sinus. The cause may be related to embryogenesis, developmental malformation, prostatitis and Perineal trauma is related, but the main factors of the triggering factors have not yet been elucidated.
Radiation-induced malignancy has been described in detail after Frieben's first report in 1902 and Perthes's 1904 report. In 1922, Beck first described radiotherapy-induced sarcoma. The literature reports that radiotherapy-induced sarcoma mainly occurs in bone, chest wall, and uterus. Breast, retroperitoneum, liver, mediastinum, pelvis, blood, muscle, thyroid, parathyroid tissue, lung and stomach, Michael Scully reports a case of prostate cancer with transurethral resection of the prostate after TURP 125 iodine (125I) implanted radiotherapy In the last 8 years, prostate sarcoma was found. In the literature, two patients who underwent local radiotherapy for prostate cancer had sarcomatoid changes. Radiotherapy may be a cause of prostate sarcoma.
(two) pathogenesis
Prostate sarcoma originates from the reproductive tract mesoderm tissue, has different pathological structures and biological behaviors. It is an extremely malignant tumor. According to cell morphology, the most common pathology of prostate sarcoma is round cell and spindle cell sarcoma. Round cell sarcoma is rich in blood vessels, often in the form of honeycomb cystic lesions, and grows rapidly. The spindle cell sarcoma is more common in children, infiltrating into the surrounding area, rapidly filling the pelvic cavity, and bulging to the perineum. The three common types of prostatic sarcoma are striated muscle. Sarcomas, leiomyosarcoma and fibrosarcoma, reticulum lymphosarcoma, angiosarcoma, malignant histiocytoma are rare.
Lowsley classifies the pathology of prostate sarcoma into three categories:
1 myomas (myosarcoma): rhabdomyosarcoma (rhabdomyosarcoma), leiomyosarcoma (leiomyosarcoma);
2 Fusocellular sarcoma includes fibrosarcoma and fusocellular sarcoma;
3 other sarcoma: mucinous sarcoma, liposarcoma, osteosarcoma, neurogenic sarcoma.
Paul summarized the clinical and pathological findings of 22 cases of prostate-specific interstitial sarcoma and related proliferative lesions. During the follow-up period, 4 cases developed into prostate sarcoma. Based on this, he proposed that the proliferative lesions may be precancerous lesions of the prostate sarcoma, sarcoma and Related specific interstitial hyperplasia lesions are rare, and only a few cases have been reported. The results use many different words to describe these lesions, such as "lobular sarcoma", "atypical sarcomatoid hyperplasia", "atypical fibrous tissue Hyperplasia, "prostate mesenchymal sarcoma", etc., in order to better determine the histological features of these lesions, they are divided into sarcomatoid hyperplasia (PSPUMP) and prostate stromal sarcoma (PSS) that cannot determine malignancy. .
Another report of rare prostate cancer sarcoma, Mayo Clinics concluded that only 21 cases of pathological data in the United States in the past 50 years, prostate cancer sarcoma is divided into two types, one is mainly adenocarcinoma, one is mainly sarcoma The histological types of sarcoma include: osteosarcoma, leiomyosarcoma, fibrosarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma and the like.
1. Can not determine the pathological features of malignant prostate interstitial hyperplasia PSPUMP can be seen to expand the interstitial range, according to cell level, interstitial cell atypical and non-tumor cell body components, PSPUMP can be divided into four pathological types.
Category 1: The most common form, characterized by stromal cell proliferation, characterized by atypical hyperplasia of cells, accompanied by benign prostate glands, interstitial cells with round, full and fusiform, nucleolar cytoplasm The contrast is clear, the atypical nuclei are enlarged, pleomorphic, occasionally multinucleated, nucleoli prominent, and the associated non-tumor prostate histopathology is not significantly different from normal non-lesional glands.
Category 2: Similar to Category 1, except for the absence of cytological atypical cells, characterized by increased interstitial cells, and non-tumor glandular components are not apparent.
Category 3: Similar to breast cancer lobulated tumors, with increased interstitial and non-neoplastic glandular components, with varying degrees of hyperplasia, atypical cells similar to Category 1, glandular components resembling epithelial lines, and breast cancer The middle lobulated tumors are similar and have different degrees of hyperplasia.
Category 4: Excessive interstitial hyperplasia, no glandular components, interstitial cells are the same as other forms of cells, but no atypical cells.
2. Pathological features of prostatic stromal sarcoma PSS cells can be round, full, fusiform, similar to PSPUMP, but with a higher pathological grade, increased nuclear chromatin, tumor cells are usually layered. It can be diffuse, mono- or short clusters.
3. Pathological features and classification of prostate rhabdomyosarcoma
(1) Embryonic rhabdomyosarcoma: mainly occurs in infants and children under the age of 10, accounting for 50% to 60% of children's sarcoma, and morphologically manifested as skeletal muscle morphology of embryonic stage 7 to 10 weeks, histology See that the cells are sparse, arranged in a loose weave, interstitial mucus degeneration is easy to see; the striated muscle cells are scattered; the poorly differentiated areas are composed of small, round or oval cells, with nuclear contamination, few cytoplasm and unclear boundaries. The well-differentiated area may have striated muscle cells, cytoplasmic red staining, and some cells may have horizontal stripes in the cytoplasm; some cases may have immature cartilage or bone tissue, and grape sarcoma refers to polyploid Sexual embryonal rhabdomyosarcoma, with a grape-like appearance protruding into the cavity tissue, and a prostate rhabdomyosarcoma is a solid mass rather than a grape.
(2) vascular (alveolar) rhabdomyosarcoma: common in adolescents aged 10 to 25 years, manifested as skeletal muscle morphology of embryos about 10 to 12 weeks, composed of poorly differentiated round or oval cells, with irregular In the acinar cavity, occasionally, the highly differentiated rhabdomyoblasts and multinucleated giant cells in the acinar cavity usually metastasize to nearby lymph nodes with poor prognosis.
(3) pleomorphic rhabdomyosarcoma: more common in adults, microscopic tumor cells are well-shaped, can appear a variety of strange rhabdomyoblasts, cytoplasm rich, red staining, visible longitudinal lines, horizontal stripes, mitotic figures see.
4. Prostatic leiomyosarcoma occurs mostly in middle-aged and elderly people. The malignancy is low, and the tumor cells are heteromorphic. The number of mitotic figures is important for judging the degree of malignancy. Those with high malignancy are prone to recurrence after surgery. The blood is transferred to the lungs, liver and other organs.
5. The tumor cells differentiated from prostate fibrosarcoma are mostly fusiform, similar to fibroids, and poorly differentiated with obvious atypia. Those with poor differentiation grow fast and are prone to metastasis.
6. Prostate angiosarcoma is very rare, originating from mesenchymal malignant tumors, differentiated from vascular endothelial cells, first described by Matthias in 1889, the tumor consists of elongated fusiform, megakaryocytes, full of pleomorphic cells, The nuclear diversity is obvious, mononuclear or multinuclear, ranging from a small and dense nucleus to a large vacuole-like nucleus. The nucleus has a cluster of chromatin, the intercellular substance is abundant, and the cells are arranged in a tight sequence, malignant. Formed vascular structures are rare in cells, and antigen-associated factor VIII immunohistochemical staining is often positive, which can play a diagnostic role and contribute to classification.
7. Prostate cancer sarcoma is a tumor that has recently been used to describe cancerous or sarcomatoid components, which are grown in two phases. According to the characteristics of light microscopy, immunohistochemistry and electron microscopy, the classification is as follows:
Type I: Light microscopy can confirm cancerous or sarcomatoid areas, and sarcomatoid areas can demonstrate epithelial differentiation by immunohistochemistry and electron microscopy.
Type II: Light microscopy suggests sarcomatoid tissue, but immunohistochemistry or electron microscopy can explain the difference in cancer.
Type III: Light microscopy showed that the cancerous and sarcoma were different, but the sarcomatoid lesions were so poorly differentiated that epithelial differentiation could not be confirmed by special examination.
Carcinosarcoma is characterized by defects in epithelial components and a history of adenocarcinoma. Pathological diagnosis of prostate cancer sarcoma is sometimes difficult. It is more difficult to distinguish between adult patients and prostate sarcomatoid adenocarcinoma. Prostate cancer requires castration treatment, and castration for prostate sarcoma. Harmful and unhelpful, so a clear pathological diagnosis is extremely important, it is best to combine light microscopy, electron microscopy and immunohistochemistry.
Its immunohistochemical detection indicators have the following categories:
(1) Mesenchymal tumor markers:
1 vimentin: vibrin of 5258 ku, distributed in mesenchymal cells and tumors of its origin. Because epithelial cells and their tumors do not contain this protein, they are specific markers of normal mesenchymal cells and their tumors. Object,
2 myoglobin: 17.8 ku of cytoplasmic protein, present in normal striated muscle tissue, is a specific marker of rhabdomyosarcoma, generally, normal, atrophic and degenerative striated muscle and myocardium, and all types of rhabdomyosarcoma Positive myoglobin expression was observed.
3 desmin (desmin): 50 ~ 55 ku of cytoplasmic protein, often located in the Z region of adult skeletal muscle, myocardial insertion area and cytoplasm of visceral smooth muscle, the latter is diffusely distributed in the uterus, skin, gastrointestinal It is positive in smooth muscle tumors of the tract and other parts, and can be expressed in embryonic or adult striated muscle or smooth muscle cells and tumors thereof.
Vimentin, myoglobin, and desmin are important tissue markers of prostate sarcoma. It has been reported in the literature that a group of 62 cases of rhabdomyosarcoma with positive anti-desmin staining of desmin antibody is the most sensitive marker of rhabdomyosarcoma.
(2) Neuronal and endocrine cell markers: S100 protein. In 1965, Moor isolated a highly acidic calcium-binding protein from bovine brain solution with a molecular weight of 21 ku. It is a nervous system-specific protein, S100 protein, which is present in In collagen cells and Schwann cells and their tumors, positive expression was observed in prostate chondrosarcoma.
(3) Epithelial tumor markers:
1 Epithelial membrane antigen (EMA): is a milk globule membrane glycoprotein secreted by epithelial cells, widely present in various epithelial cells and their tumor tissues, also in mesothelial cells, plasma cells, tissue cells and T cells. Lymphoma, especially the poorly differentiated cancer EMA can sometimes be strongly positively expressed, and EMA can be used as a common marker for epithelial-derived tumors.
2 prostate specific antigen,
3 prostatic acid phosphatase,
4 keratin.
The above four epithelial-derived markers are negative in prostate sarcoma tissue and positive in adenocarcinoma components, which is beneficial for differential diagnosis.
Prostatic sarcoma grows rapidly, is large, rarely within 5cm, and has a maximum diameter of 20cm. It can fill the entire pelvic cavity. In 1951, Kawaichi and Cooper reported that a leiomyosarcoma weighs more than 3kg. The appearance of the tumor is no different from other tissue sarcomas. Tumors often surround the bladder neck, prone to complete urinary retention, such as the perineum or rectum can cause defecation obstacles, the large can compress the lower ureter caused by the kidney, ureteral water, invasion of the pelvis can cause osteolytic destruction, early cause of vascular lymph Infiltration, local lymphatic metastasis can be transferred to the lungs, liver, bones, etc. through blood, 75% of lesions can be locally extended to the urethra, bladder, seminal vesicles, etc.
Staging:
Ghavimi is divided into 4 stages depending on the extent of the tumor and whether it can be removed. It also has a certain significance for treatment and prognosis:
Stage I: The tumor is limited, can be completely removed, and the regional lymph nodes are negative.
IA: Negative cut edge microscopy.
IB: Positive edge examination.
Stage II: The tumor infiltrates into adjacent tissues and cannot be completely removed, while the regional lymph nodes are negative.
Stage III: The tumor spreads to adjacent tissues and cannot be completely removed. The regional lymph nodes are positive for microscopy.
Stage IV: distant transfer.
Prevention
Prostate sarcoma prevention
The cause is still unclear, to understand the risk factors of tumors, and to develop appropriate prevention strategies to reduce the risk of cancer. There are two basic clues to prevent tumors. Even if tumors have begun to form in the body, they can help the body to improve resistance. The current focus of cancer prevention and treatment work should focus on and improve those factors that are closely related to our lives, such as Quit smoking, eat properly, exercise regularly, and lose weight. Anyone who follows these simple and reasonable lifestyles can reduce their chances of developing cancer.
Complication
Prostatic sarcoma complications Complications anemia prostate cancer
A malignant lesion has occurred. The course of prostate sarcoma is extremely rapid, rapid growth, and poor prognosis. The prognosis of children is particularly poor. After a clear diagnosis, most cases survive for less than one year. Rhabdomyosarcoma is extremely malignant and has the fastest growth rate, almost all within one year. The leiomyosarcoma and fibrosarcoma grow slowly, the prognosis is slightly better, and the average survival is 2 to 3 years.
Symptom
Symptoms of prostate sarcoma Common symptoms Hematuria, frequent urination, urinary retention, weight loss, dysuria, cachexia
The disease does not show symptoms in the early stage. When the symptoms appear, the tumor is quite large. Generally, the early symptoms are bladder neck obstruction. Tumor compression of the bladder bottom or invasion of the urethra can affect urination. It is characterized by frequent urination, dysuria and dysuria, and gross hematuria. Uncommon, severe pressure on the rectum causes difficulty in defecation, late symptoms are pain, obvious weight loss, anemia and cachexia, easy to transfer to the lungs, liver, bone.
Examine
Prostate sarcoma examination
1. Laboratory examinations are rare and abnormal, urine routine can have microscopic hematuria, leukocytosis can occur in the urine when obstruction is combined with infection, blood routine examination is mostly in the normal range, late can have anemia, erythrocyte sedimentation rate increases, tumor compression ureteral lower end Can cause hydronephrosis, renal dysfunction, blood urea nitrogen, creatinine increased.
2. Prostate specific antigen, prostate specific acid phosphatase assay prostate specific antigen is a glycoprotein produced by normal or cancerous prostate epithelial cells, which is a sensitive tumor marker for prostate cancer. Prostate specific acid phosphatase is an acid phosphatase isoenzyme. Prostate epithelial cell lysosome production, organ specificity is higher than acid phosphatase, prostate sarcoma occurs in the prostate interstitial, prostate specific antigen, prostate specific acid phosphatase detection in the normal range helps to distinguish from prostate cancer.
Other auxiliary inspections:
1. B-ultrasound showed that the enlargement of the prostate volume protruded into the bladder, and the echo of the capsule was irregular or defective, and there was a substantial low recovery zone.
2. CT can be seen that tumor necrosis leads to isolated low-density areas and signs of bladder, rectum, and pelvic muscle involvement.
3. Cystoscopy The bladder volume is reduced due to the inward compression of the bladder. The bladder neck and the triangle area compress the bladder from the outside to the inside, showing an external pressure mass.
4. Bladder urethrography shows that the bladder and urethra are compressed, deformed, displaced, and there is a huge protrusion in the bladder neck that fills the bladder.
5. IVU examination Most patients with IVU often have no obvious abnormalities. If the lower end of the double ureter is compressed by the tumor and is displaced upward, the IVU is characterized by double ureter, dilated pelvis of the renal pelvis, and the ureter is folded back into a hook shape.
6. X-ray examination X-ray pelvic plain film examination showed bone damage when the tumor had metastasis. Prostatic sarcoma bone metastasis was different from bone metastasis of prostate cancer. Osteoma bone metastasis was more extensive than prostate cancer, and it was osteolytic destruction. The bone metastasis of prostate cancer is often osteogenic.
7. Nuclide examination Recently, the immunological scanning of 131I (131 iodine)-labeled monoclonal antibody RuD10 has been reported in the literature, which plays an important role in the diagnosis of rhabdomyosarcoma. This method is an important supplement to the existing diagnostic methods and has bone in the tumor. At the time of transfer, the radionuclide bone scan showed bone lesions.
8. MRI examination of magnetic resonance in tumor staging is more versatile, with better contrast resolution and spatial resolution, MRI scan in the sagittal and coronal plane, making it in the diagnosis of bladder neck and bladder top tumor There are great advantages in aspects, such as tumor invasion of the prostate and seminal vesicles, then MRI has a good application value.
9. Prostate biopsy is an extremely important method of examination, which can be used to obtain a pathological diagnosis, and to determine the type of pathological tissue. It is of great significance for the treatment of advanced patients who cannot be treated with surgery.
In recent years, the perineal acupuncture biopsy has been proved to have a certain value in the diagnosis of prostate tumors. Acupuncture biopsy has a certain false negative rate, but multiple cylindrical tissue methods can be adopted to provide more typical methods for microscopy. Materials to improve the diagnostic level.
Transrectal prostate biopsy provides a more accurate method for tumor puncture. Although the rectal infection area, the complications are not more common than perineal puncture.
Aspiration cytology usually uses a fine needle aspiration through the rectum, which often does not make a definitive diagnosis. It is also difficult for cytopathologists to distinguish between benign atypical prostate stromal hyperplasia and well differentiated tumor cells. Often used.
Diagnosis
Diagnosis and diagnosis of prostate sarcoma
diagnosis
Children or children under 40 years of age have difficulty urinating, especially with obvious constipation, anal finger touches painless prostate mass, cystic fluctuation, bladder volume shrinkage, cystic microscopic mass in the neck, angiography sees the bladder neck huge filling Defect and urethral displacement deformation, pelvic B-ultrasound and CT have diagnostic value, and biopsy can obtain pathologically confirmed diagnosis.
Differential diagnosis
Prostatic cyst
Frequent urination, urgency, dysuria and other symptoms; rectal examination of the prostate enlargement, sac sexy; but the sac fluid can be withdrawn when puncture; B-mode ultrasound has a round or oval sound-transparent area, the boundaries are neat.
2. Prostate abscess
Frequent urination, urgency, poor urination, painful bowel movements and other symptoms, but the systemic symptoms are obvious, such as fever, chills, etc., rectal examination of prostate tenderness is obvious; prostatic fluid microscopic examination has more pus cells, culture can find pathogenic bacteria, B-mode ultrasonography, a poorly bordered sound-transparent area or an internal hypoechoic area in the prostate, pus can be obtained by puncture.
3. Seminal vesicle tumor
Seminal vesicle malignant tumors are rare, mainly adenocarcinoma, the age of onset is 24-90 years old, an average of 62 years old, 40% before the age of 40, the symptoms are blood, urinary thick gelatinous, intermittent hematuria, frequent urination and Difficulties in urination, etc., rectal examination touches irregular lumps above the prostate, and the boundary is unclear with the prostate. The venography of the urinary tract shows one or both sides of the ureteral obstruction. The cystoscopy reveals the triangle or neck elevation, seminal vesicle angiography. At the time, the seminal vesicle is blocked, deformed or filled, and the normal seminal sac of the seminal vesicle has a horn-shaped low echo on the posterior side of the bladder. The tip is upward, the bottom is connected with the prostate, and the inside has a strip echo, which faintly separates the seminal vesicle. The cut surface is seen in the circular hypoechoic area on the posterior side of the bladder. The ultrasound image of the seminal vesicle tumor is characterized by enlargement of the seminal vesicle, thickening, morphological abnormality, internal strip echo disappearing, or discharge of the seminal vesicle due to cancer, seminal vesicle deposit, and morphological enlargement. CT and magnetic resonance imaging showed lesions in the seminal vesicle area and showed tumor extent and lymph node metastasis.
4. Prostate sarcoma also needs to be differentiated from prostate cancer, benign prostatic hyperplasia, cysticercosis, and post-bladder abdominal tumors.
