Small cell carcinoma of the prostate is a rare neoplasm, with only a few series hitherto reported. A little less than half of the cases prostata adenocarcinoma ICD 10 associated with conventional acinar adenocarcinoma, which are usually high grade. Although consensus has not been reached, the majority of patients with small cell neuroendocrine carcinoma of the prostate have advanced disease at diagnosis and disproportionally low PSA levels compared to patients with conventional acinar adenocarcinoma.
Treatment consists mainly of chemotherapy prostata adenocarcinoma ICD 10 with surgery. Radiation therapy is reserved for selected cases. This study reviews the most up-to-date information on small cell carcinomas of the prostate. Small cell neuroendocrine carcinoma of the prostate is prostata adenocarcinoma ICD 10 very uncommon type of prostate cancer, which was first described by Wenk et al. Lacking a specific classification, neuroendocrine tumors of the prostate are usually reported as carcinoid tumors, which are low-grade neuroendocrine carcinomas, and high-grade neuroendocrine carcinoma, which encompasses large neuroendocrine, small cell neuroendocrine prostata adenocarcinoma ICD 10, and combined tumors, based on their histological and immunophenotypical profile [ 2 — 7 ].
Barely more than half of small cell carcinomas arising in the prostate are pure without an associated nonsmall cell component. A large number of cases are detected after androgen ablation therapy for conventional adenocarcinoma. In these situations, conventional acinar adenocarcinoma cells may differentiate along neuroendocrine lines [ 8 ]. The importance in recognizing small cell neuroendocrine carcinoma resides in its histological overlap with primary high Gleason-grade tumors of the prostate and its biological behavior, which implies in a different clinical presentation and treatment approach [ 910 ].
Herein, we review the most up-to-date information on small cell neuroendocrine carcinoma of the prostate, focusing on its histological, immunophenotypical profile as prostata adenocarcinoma ICD 10 the most important differential diagnosis. Brief considerations on molecular pathology advances as well as treatment options are also stated. A literature search for small cell neuroendocrine carcinoma of the prostate was performed. Referred articles were selected and reviewed, and data concerning clinical data of cancer occurrence, prostata adenocarcinoma ICD 10 settings, immunohistochemical and molecular profiles, and treatment options are here prostata adenocarcinoma ICD 10.
Small cell neuroendocrine carcinoma is rare outside the lung. PSA serum levels can vary from undetectable, especially in cases of conventional acinar tumors with prior hormone treatment, to high levels, with a mean level of 4.
In this series, the interval between the diagnosis of small cell carcinoma subsequent to one of conventional tumors had a mean of 25 months [ 6 ]. Interestingly, in another series focusing on large cell neuroendocrine carcinoma LCNECthe interval between initial diagnosis of conventional tumor prostata adenocarcinoma ICD 10 higher, with a mean of 4. Stage at presentation seems also to be higher in cases of tumors with neuroendocrine differentiation that were not subject to hormonal treatment [ 20 ].
Histological findings are identical to those tumors arising in extraprostatic sites: in small cell carcinoma, neoplastic cells are arranged mostly prostata adenocarcinoma ICD 10 a monomorphic pattern of small round or fusiform cells containing prostata adenocarcinoma ICD 10 or convoluted hyperchromatic nuclei with a salt-and-pepper pattern chromatin, rarely with one prostata adenocarcinoma ICD 10 more discernible small nucleoli Figure 1.
The classic morphology is characterized by cells only slightly larger than lymphocytes with open prostata adenocarcinoma ICD 10 and inconspicuous nucleoli, wherein the intermediate cell type, the tumor cells have more abundant cytoplasm, larger nuclei, and occasional visible nucleoli prostata adenocarcinoma ICD 10 6 ].
Low power of small cell carcinoma left associated with Gleason prostata adenocarcinoma ICD 10 acinar adenocarcinoma right. Pure small cell neuroendocrine carcinomas of the prostate are slightly more common than mixed small cell-adenocarcinomas. Cytoplasm is scant. Mitoses are readily discernible and can be numerous.
Necrosis is another common histological finding but is usually not extensive. Perineural invasion is also common Figure 4. Larger atypical cells, formation of true rosettes or pseudorosettes, and a large clear and vacuolated cytoplasm are also described. Another spectrum of neuroendocrine differentiation encompasses Paneth cell-like change. This phenomenon was reported by Weaver et al. Its true neuroendocrine origin is confirmed by immunohistochemical and electron microscopy studies [ 27 ].
The same case as in Figure 2. Note gradual merging of small cell carcinoma with glands prostata adenocarcinoma ICD 10 acinar adenocarcinoma.
Perineural invasion by the small cell carcinoma component, diagnosed in a needle biopsy. For the surgical pathologist, the most critical and common issue concerning the diagnosis of a small cell neuroendocrine carcinoma is its confusion with a poorly differentiated acinar adenocarcinoma Gleason 5notably those with a solid pattern without gland formation and central necrosis in a small focus on needle biopsies.
Indeed, misdiagnosing small cell carcinomas as high-grade acinar adenocarcinoma seems to occur commonly. Studies reveal a 0. Although not required for the diagnosis of small cell carcinoma, immunohistochemical studies may be helpful Table 1.
TTF-1 can be positive in up to half of small cell carcinomas and is not found in the poorly differentiated adenocarcinomas [ 617 ]. Most small cell carcinomas are negative for the aforementioned prostate markers PSA, PSAP, and PSwith some rare cases showing focal positivity, while poorly differentiated adenocarcinomas are usually diffusely positive for the same antibodies.
Expression of neuroendocrine markers can be seen in conventional acinar adenocarcinomas, and the diagnosis of neuroendocrine carcinomas should rely in both immunohistochemical profile and light microscopic morphology. PSA immunostain showing strong positivity in benign prostate glands, whereas the neuroendocrine tumor is faint to absent.
Immunohistochemical findings of small cell carcinoma of the prostate compared with conventional high-grade adenocarcinomas [ 6810172030 — 35 ]. Pulmonary small cell carcinomas are aggressive neoplasms commonly in advanced stages at diagnosis.
PSA serum levels are not commonly elevated in primary small cell carcinomas of the prostate, and its levels are not helpful in separate metastatic lung disease from prostate small cell carcinoma. Immunohistochemistry can be helpful in distinguishing them, as small cell carcinomas can be positive even focally for at least one prostatic prostata adenocarcinoma ICD 10 PSA, PSMA, PSAP, or Ps which are not expressed in lung tumors [ 36 ]. Two recent papers have addressed the issue of the translocation in small cell carcinomas of the prostate.
Guo et prostata adenocarcinoma ICD 10. In a prostata adenocarcinoma ICD 10 study, Lotan et al. These findings strongly suggest a common pathway of genesis of conventional acinar and also small cell carcinoma of the prostate. More recent data on molecular characterization of small cell carcinoma of the prostate reported by Tai et al. Indeed, those cells are immunohistochemically characterized by the expression of CD44, a stem cell marker commonly reported and believed to be more specific for small cell carcinoma of the prostate.
On the contrary, conventional adenocarcinoma do not show CD44 positivity and have expression of PSA and androgen receptors like LNCaP, another known cell line associated with prostatic carcinoma [ 39 ]. The treatment of small cell carcinoma of the prostate includes a multimodality approach with chemotherapy as the prostata adenocarcinoma ICD 10 of treatment, and radiation as supplemental for local control or for palliation.
However, no uniform treatment being clearly established. Regimens that include gemcitabine, docetaxel and carboplatin, or cisplatin have been attempted with variable success [ 40 — 42 ].
Radiotherapy is also used, since patients with a small carcinoma diagnosis are not common candidates for surgical treatment [ 10144344 ]. However, primary surgery was the most important prognostic factor for prolonged survival in one study [ 45 ]. Neuroendocrine differentiation may play an important role in the development of androgen resistance [ 1441 ], and advanced prostatic carcinomas with pure or partial neuroendocrine differentiation have a median survival of only 10 months.
However, a case of mixed conventional acinar adenocarcinoma and small cell neuroendocrine carcinoma recently reported by Brammer et al. Another potential target for the treatment of small prostata adenocarcinoma ICD 10 neuroendocrine carcinoma is the relaxin receptor RXFP1. Relaxin is a small peptide hormone expressed in several cancers such as those of endocrine origin.
Its receptor, RXFP1 a G-protein-coupled receptoris expressed in androgen receptors' positive and negative cancers, as well as in prostate germ cells.
In Prostata adenocarcinoma ICD 10 prostate cancer cell lines, which include small cell neuroendocrine carcinoma, treatment of RXFP1 showed significant reduction of tumor size, decrease in cell proliferation and metastatic disease, and increased apoptosis [ 47 ]. National Center for Biotechnology InformationU. Journal List Prostate Cancer v. Prostate Cancer. Published online Aug 4. Prostata adenocarcinoma ICD 101, 2M.
Lima3 C. Nogueira3 M. Franco1 and F. Author information Article notes Copyright and License information Disclaimer. Tavora: moc. Furtado et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.
Abstract Small cell carcinoma of the prostate is a rare neoplasm, with only a few series hitherto reported. Introduction Small cell neuroendocrine carcinoma of the prostate is a very uncommon type of prostate cancer, which was first described by Wenk et al.
Methods A literature search for small cell neuroendocrine carcinoma of the prostate was performed. Discussion Small cell neuroendocrine carcinoma is rare outside the lung. Open in a separate window. Figure 1. Figure 2. Combined acinar adenocarcinoma and small cell carcinoma diagnosed in a needle biopsy. Figure 3. Figure 4. Figure 5. Figure 6. Small cell carcinoma with strong positivity for chromogranin immunostain.
Table prostata adenocarcinoma ICD 10 Immunohistochemical findings of small cell carcinoma of the prostate compared with conventional high-grade adenocarcinomas [ 6810172030 — 35 ]. References 1. Ectopic ACTH, prostatic oat cell carcinoma, and marked hypernatremia. Large cell neuroendocrine carcinoma of prostate: a clinicopathologic summary of 7 cases of a rare manifestation of advanced prostate cancer.
American Journal of Surgical Pathology. A pure primary low-grade neuroendocrine carcinoma carcinoid tumor of the prostate. International Urology and Nephrology.