ホルモン療法中に急速に進行した前立腺の腺扁平上皮癌

A case of adenosquamous carcinoma of the prostate with rapid progression during hormone therapy

　78歳男性．CTで右水腎症，右骨盤底リンパ節腫大を認めた．PSA値は164.41ng/mL，前立腺生検でAdenocarcinoma，Gleason score 4＋4＝8を検出した．ホルモン療法を開始後，PSA値は低下したが4か月後に会陰痛が出現した．MRIで10cm大の直腸を圧迫する腫瘤性病変を認め，経直腸生検で扁平上皮癌が検出，前立腺の腺扁平上皮癌の最終診断となった．

Abstract

Adenosquamous carcinoma of the prostate is a rare histological variant with clinical aggressive form of prostate cancer. A 78-year-old man was incidentally found to have right hydronephrosis and lymph node swelling in pelvic floor by computed tomography. The serum prostate-specific antigen (PSA) level was 164.41 ng/mL. Transperineal prostate biopsy revealed a Gleason score 8 (4 + 4) prostatic adenocarcinoma. Although he was treated with combined androgen deprivation therapy with good PSA response, perineal pain had appeared 4 months later. Magnetic resonance imaging revealed enlarged prostate heterogeneous mass of 10cm in diameter which was compressing the rectum. Transrectal needle biopsy of the tumor showed squamous cell carcinoma, and he was finally diagnosed as adenosquamous carcinoma of the prostate (Rinsho Hinyokika 72 : 657-660, 2018).