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Sakalauskaite M, Garnelyte A, Civilka I, Dulskas A, Kincius M, Patasius A. Prostate Adenocarcinoma with Signet-Ring Cells and Features of Mucin: A Clinical Case and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:877. [PMID: 38929494 PMCID: PMC11205309 DOI: 10.3390/medicina60060877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Introduction: Signet-ring cells are typically associated with mucin-secreting epithelium; thus, they are most commonly found in the gastrointestinal tract, but not exclusively. Primary signet-ring cell carcinoma of the prostate is a rare and poorly differentiated, aggressive acinar adenocarcinoma variant with a grim prognosis. Clinical Case: In June of 2023, a 54-year-old Caucasian male presented with a complaint of lower urinary tract obstructive symptoms with occasional macrohematuria, non-specific body aches, and shortness of breath. A prostate specimen obtained in transurethral resection of the prostate was sent for histopathological examination. After a series of extraprostatic diagnostic workups, including fibrogastroduodenoscopy, colonoscopy computed tomography imaging, and immunohistochemical studies, the patient was diagnosed with primary prostatic signet-ring cell adenocarcinoma stage IV. Unfortunately, due to the advanced stage of the disease, PE, and third-degree thrombocytopenia, the patient was not a candidate for chemotherapy and died of cardiopulmonary insufficiency later that week. Discussion: Prostatic signet-ring cell carcinoma accounts for 0.02% of all prostate adenocarcinoma cases. Due to its nature and epidemiology, a diligent extraprostatic investigation has to be carried out. The disease often presents with unremarkable clinical symptoms and variable serum prostate-specific antigen results, which may contribute to its late diagnosis. Inconsistent immunohistochemical findings and an unpredictable response to hormonal treatment together pose both diagnostic and therapeutic challenges that negatively affect the prognosis. Conclusions: This study highlights the importance of a multidisciplinary approach and the need for diagnostic and therapeutic consensus within the research community in search of the primary site of the disease, which may positively influence the prognosis.
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Affiliation(s)
- Migle Sakalauskaite
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Department of Oncourology, National Cancer Institute, 08406 Vilnius, Lithuania; (M.K.); (A.P.)
| | - Ausra Garnelyte
- National Center of Pathology, Vilnius University Hospital Santaros Clinics, 08661 Vilnius, Lithuania;
| | - Ignas Civilka
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, 08406 Vilnius, Lithuania; (I.C.); (A.D.)
| | - Audrius Dulskas
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, 08406 Vilnius, Lithuania; (I.C.); (A.D.)
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
| | - Marius Kincius
- Department of Oncourology, National Cancer Institute, 08406 Vilnius, Lithuania; (M.K.); (A.P.)
| | - Ausvydas Patasius
- Department of Oncourology, National Cancer Institute, 08406 Vilnius, Lithuania; (M.K.); (A.P.)
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
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Koufopoulos N, Ieronimaki AI, Zacharatou A, Gouloumis AR, Leventakou D, Boutas I, Dimas DT, Kontogeorgi A, Sitara K, Khaldi L, Zanelli M, Palicelli A. A Case of Prostatic Signet-Ring Cell-like Carcinoma with Pagetoid Spread and Intraductal Carcinoma and Long-Term Survival: PD-L1 and Mismatch Repair System Proteins (MMR) Immunohistochemical Evaluation with Systematic Literature Review. J Pers Med 2023; 13:1016. [PMID: 37374005 DOI: 10.3390/jpm13061016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
Prostatic adenocarcinoma (PA) is the second most common malignancy in men globally. Signet-ring cell-like adenocarcinoma (SRCC) is a very rare PA subtype, with around 200 cases reported in the English literature. Histologically, the tumor cells show a vacuole compressing the nucleus to the periphery. Pagetoid spread in acini and ducts is usually related to metastases from urothelial or colorectal carcinomas, less commonly associated with intraductal carcinoma (IC); histologically, the tumor cells grow between the acinar secretory and basal cell layers. To our knowledge, we report the first prostatic SRCC (Gleason score 10, stage pT3b) associated with IC and pagetoid spread to prostatic acini and seminal vesicles. To our systematic literature review (PRISMA guidelines), it is the first tested case for both PD-L1 (<1% of positive tumor cells, clone 22C3) and mismatch repair system proteins (MMR) (MLH1+/MSH2+/PMS2+/MSH6+). We found no SRCC previously tested for MMR, while only four previous cases showed high expression of another PD-L1 clone (28-8). Finally, we discussed the differential diagnoses of prostatic SRCC.
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Affiliation(s)
- Nektarios Koufopoulos
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 15772 Athens, Greece
| | - Argyro-Ioanna Ieronimaki
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 15772 Athens, Greece
| | - Andriani Zacharatou
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 15772 Athens, Greece
| | - Alina Roxana Gouloumis
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 15772 Athens, Greece
| | - Danai Leventakou
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 15772 Athens, Greece
| | - Ioannis Boutas
- Breast Unit, Rea Maternity Hospital, P. Faliro, 17564 Athens, Greece
| | - Dionysios T Dimas
- Breast Unit, Athens Medical Center, Psychiko Clinic, 11525 Athens, Greece
| | - Adamantia Kontogeorgi
- Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 15772 Athens, Greece
| | - Kyparissia Sitara
- Department of Internal Medicine, "Elpis" General Hospital of Athens, 11522 Athens, Greece
| | - Lubna Khaldi
- Pathology Department "Saint Savvas" Anti-Cancer Hospital, 10447 Athens, Greece
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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Li P, Zhou Z, Bao M, Li J, Meng X, Liu B, Tang M. Diagnosis and Management of Primary Prostatic Signet Ring Cell Carcinoma: Single-Center Experience. Am J Mens Health 2022; 16:15579883221087839. [PMID: 35315313 PMCID: PMC8943559 DOI: 10.1177/15579883221087839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of the study was to retrospectively summarize the diagnosis and
management of 10 primary prostatic signet ring cell carcinoma (PPSRCC) cases in
our center. Ten PPSRCC patients diagnosed at the First Affiliated Hospital of
Nanjing Medical University from November 2014 to December 2020 were included.
Clinical characteristics, image features, therapeutic procedures, histological
diagnosis, and outcomes were retrospectively analyzed. All patients received
prostate-specific antigen (PSA) examination preoperatively. Nine of them
accepted multiparametric magnetic resonance imaging (mpMRI) due to elevated PSA
value, and further biopsied. Among them, five patients were diagnosed as
prostatic adenocarcinoma and the other four cases were found a mixture of signet
ring cell carcinoma (SRCC) and adenocarcinoma. Furthermore, gastrointestinal
endoscope and abdominal computed tomography (CT) did not find SRCC originating
in gastrointestinal tract. Therefore, these cases were considered to be PPSRCC.
Nine patients accepted laparoscopic or robot-assisted RP. Only one patient with
normal PSA adopted transurethral resection of the prostate. Postoperative
pathological results confirmed SRCC mixed with prostatic adenocarcinoma in nine
cases, and only one patient with pure SRCC. After surgery, nine patients
received adjuvant hormone therapy, one of which accepted radiotherapy
simultaneously. The patient with pure SRCC did not accept any adjuvant therapy
postoperatively. During a mean follow-up of 31.9 months, only four patients were
alive without disease progression. In summary, PPSRCC is a rare malignant tumor
with few specific symptoms, rapid disease progression, and poor prognosis and is
frequently accompanied by high-grade prostate adenocarcinoma patterns. There is
still no clear and effective strategy to improve the prognosis.
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Affiliation(s)
- Pu Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zihan Zhou
- Department of First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Meiling Bao
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoxin Meng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bianjiang Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Tang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Gök A, Tuygun C, Akmansu M, Uslu AA, Kartal IG, Sandikçi F, Karabacak OR, Sağnak AL, Topaloğlu H, Ersoy H. Primary Signet Ring Cell Carcinoma of the Prostate: A Rare Case Report. J Clin Med 2018; 7:jcm7080218. [PMID: 30111751 PMCID: PMC6112034 DOI: 10.3390/jcm7080218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022] Open
Abstract
Primary prostatic signet ring cell carcinoma is a rare form of cancer with a poor prognosis, which is generally treated with a traditional prostate adenocarcinoma therapy. This case report presents a 70-year-old diagnosed with primary prostatic signet ring cell carcinoma, treated with a combination of radiotherapy and hormone therapy and a 16 month survival without an evidence of the disease at follow up.
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Affiliation(s)
- Alper Gök
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara 06030, Turkey.
| | - Can Tuygun
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara 06030, Turkey.
| | - Müge Akmansu
- Department of Radiation Oncology, Gazi University Medical Faculty, Ankara 06560, Turkey.
| | - Ayşegül Aksakal Uslu
- Department of Pathology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara 06030, Turkey.
| | - Ibrahim Güven Kartal
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara 06030, Turkey.
| | - Fatih Sandikçi
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara 06030, Turkey.
| | - Osman Raif Karabacak
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara 06030, Turkey.
| | - Azmi Levent Sağnak
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara 06030, Turkey.
| | - Hikmet Topaloğlu
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara 06030, Turkey.
| | - Hamit Ersoy
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara 06030, Turkey.
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5
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Mucin-producing tumors and tumor-like lesions involving the prostate: a comprehensive review. Adv Anat Pathol 2012; 19:374-87. [PMID: 23060063 DOI: 10.1097/pap.0b013e318271a361] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Mucin-producing tumors of the prostate include both primary and secondary tumors with mucinous differentiation or features involving the prostate gland. These tumors are relatively rare and have variable prognostic and therapeutic implications. Primary mucinous (colloid) adenocarcinoma of the prostate is defined as prostatic adenocarcinoma with mucinous differentiation involving 25% or more of the entire tumor. Another primary tumor of the prostate that may have mucinous features is primary mucin-producing urothelial-type adenocarcinoma of the prostate (mucinous prostatic urethral adenocarcinoma). Primary mucin-producing urothelial-type adenocarcinoma of the prostate is a distinct entity that typically arises from the prostatic urethra possibly from urethritis glandularis or glandular metaplasia with malignant transformation, and it is analogous to adenocarcinoma with mucinous differentiation arising from the urinary bladder. Signet ring cell tumors of the prostate, though rare, may also have mucinous features. Secondary tumors with mucinous differentiation that may involve the prostate include adenocarcinomas of the urinary bladder and colorectum. Pathologists should also be aware of mucin-producing tumor-like lesions involving the prostate, including mucinous metaplasia, and benign Cowper glands that may mimic malignancy. Herein we present an updated and comprehensive review of the clinicopathologic, immunohistochemical, molecular, and prognostic features of mucinous tumors and tumor-like lesions involving the prostate gland, with emphasis on mucinous prostatic adenocarcinoma and its mimickers, including potential diagnostic pitfalls.
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Warner JN, Nakamura LY, Pacelli A, Humphreys MR, Castle EP. Primary signet ring cell carcinoma of the prostate. Mayo Clin Proc 2010; 85:1130-6. [PMID: 21123640 PMCID: PMC2996149 DOI: 10.4065/mcp.2010.0463] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nine patients treated with primary signet ring cell carcinoma of the prostate were identified among 29,783 cases of prostate cancer evaluated at Mayo Clinic from January 15, 1970, until January 2, 2009. A PubMed search of the English-language literature published from January 1, 1980, to January 1, 2010, was then performed using the key words signet ring cell and prostate, identifying 42 cases. This study reviews those cases, along with the additional 9 reported herein, and evaluates clinical characteristics, histologic diagnoses, treatment modalities, and outcomes. Mean age at diagnosis was 68 years (range, 50-85 years), and mean prostate-specific antigen level was 95.3 ng/mL (range, 1.9-536.0 ng/mL; to convert to μg/L, multiply by 1). Most patients (66%) had non-stage IV carcinoma, the most common Gleason sum was 8 (33%), and mean survival was 29 months. The presence of a primary signet ring cell carcinoma of the prostate was best confirmed by negative findings on gastrointestinal work-up, a positive stain for prostate-specific acid phosphatase, and negative carcinoembryonic antigen test results.
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Affiliation(s)
- Jonathan N Warner
- Department of Urology, Mayo Clinic in Arizona, Phoenix, AZ 85054, USA.
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Lilleby W, Axcrona K, Alfsen GC, Urnes T, Hole KH. Diagnosis and treatment of primary signet-ring cell carcinoma of the prostate. Acta Oncol 2008; 46:1195-7. [PMID: 17851841 DOI: 10.1080/02841860701367886] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fujita K, Sugao H, Gotoh T, Yokomizo S, Itoh Y. Primary signet ring cell carcinoma of the prostate: report and review of 42 cases. Int J Urol 2004; 11:178-81. [PMID: 15009368 DOI: 10.1111/j.1442-2042.2003.00763.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a case of primary signet ring cell carcinoma of the prostate in a 75-year-old man. Serum prostate specific antigen (PSA) level at presentation was 9.3 ng/mL. The tumor was confined within the right prostate lobe and the patient was treated with neoadjuvant hormonal therapy and radical prostatectomy. He was alive with no evidence of disease 12 months after surgery. None of the tumor was stained with periodic acid-Schiff and Alcian blue. Immunohistochemically, the tumor was positive for PSA and prostatic acid phosphatase and negative for carcinoembryonic antigen. We reviewed 41 previously reported cases of signet ring cell carcinoma of the prostate, examining both histopathological and clinical information.
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Affiliation(s)
- Kazutoshi Fujita
- Department of Urology Pathology, Minoh Municipal Hospital, Osaka, Japan.
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Akagashi K, Tanda H, Kato S, Ohnishi S, Nakajima H, Nanbu A, Nitta T, Koroku M. Signet-ring cell carcinoma of the prostate effectively treated with maximal androgen blockade. Int J Urol 2003; 10:456-8. [PMID: 12887370 DOI: 10.1046/j.1442-2042.2003.00649.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary signet-ring cell carcinoma (SRCC) of the prostate is very rare and has a poor prognosis, even when treated with aggressive therapy. We report herein a case of a 72-year-old man with prostatic SRCC. The patient had a tumor that extended directly to the rectum. Maximal androgen blockade was started and 20 months later, the patient was alive without evidence of recurrence. The present case of prostatic SRCC responded well to medical therapy, however, tumors can recur after a long period of time. Therefore, adjuvant therapy is recommended.
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Affiliation(s)
- Keigo Akagashi
- Department of Urology, Sanjukai Hospital, Sapporo, Hokkaido, Japan.
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Abstract
Many rare variants of prostatic carcinoma have been described and characterized in recent years. Accurate diagnosis of these variants is necessary in order to determine appropriate therapy. Unusual tumors arising in the prostate raise questions of histogenesis, and may carry a better or worse prognosis than typical adenocarcinoma. Virtually the entire spectrum of cellular differentiation has been observed within prostatic epithelium, and rare neoplasms exhibit these unusual forms of differentiation as the chief component of the tumor. Except in sarcoma (marked prostatic enlargement), imaging plays a limited role in the diagnoses of these entities. Biopsy and histologic diagnoses are essential and the role of imaging is restricted to the evaluation of locoregional and distant spread of the disease.
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Affiliation(s)
- S L Varghese
- Department of Radiology, University of California San Francisco, USA.
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Kuroda N, Yamasaki I, Nakayama H, Tamura K, Yamamoto Y, Miyazaki E, Naruse K, Kiyoku H, Hiroi M, Enzan H. Prostatic signet-ring cell carcinoma: case report and literature review. Pathol Int 1999; 49:457-61. [PMID: 10417691 DOI: 10.1046/j.1440-1827.1999.00876.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Signet-ring cell carcinoma (SRCC) of the prostate is a very rare neoplasm and there have been only 38 cases reported to date. Here the 39th case of prostatic SRCC containing a small amount of neutral mucin, prostatic specific antigen (PSA) and prostatic specific acid phosphatase (PSAP) in the signet-ring cells is reported. It was also found that some intracytoplasmic lumina were derived from the shallow or deep invagination of luminal membranes of cancer cells that formed the neoplastic glands. Using immunohistochemistry, a combination of monoclonal antibodies against cytokeratins 7 and 20 as well as PSA and PSAP may be useful in differentiating prostatic primary SRCC from metastatic SRCC originating in the gastrointestinal tract.
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Affiliation(s)
- N Kuroda
- First Department of Pathology, Kochi Medical School, Nankoku city, Japan
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