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Abstract
Neuroendocrine differentiation in prostatic malignancy is receiving considerable attention; this occurs commonly as a “focal” histological variant and, most rarely, in the form of small cell carcinoma (“oat cell carcinoma”) and carcinoid tumor. In prostate cancer, neuroendocrine differentiation may be the response to androgen deprivation and neuroendocrine products, either biogenic amines or peptides, have been shown to stimulate proliferation of androgen-ablation refractory cancer cells. Serum chromogranins, neuron-specific enolase and other neuroendocrine products as well as 111-In-chromogranin A “three step” immunoscintigraphy and somatostatin-receptor scintigraphy may be useful for predicting tumor behaviour and patient prognosis. Several of the neuroendocrine products, particularly somatostatin analogues, are candidates for new therapeutic approaches. The paper aims to outline the advances in this field on the basis of the review of the literature.
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Affiliation(s)
- C. Alberti
- I Clinica Urologica, Università degli Studi di Torino, Torino
| | - A. Tizzani
- I Clinica Urologica, Università degli Studi di Torino, Torino
| | - A. Greco
- I Clinica Urologica, Università degli Studi di Torino, Torino
| | - M. Piovano
- I Clinica Urologica, Università degli Studi di Torino, Torino
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Rueda-Camino JA, Losada-Vila B, De Ancos-Aracil CL, Rodríguez-Lajusticia L, Tardío JC, Zapatero-Gaviria A. Small cell carcinoma of the prostate presenting with Cushing Syndrome. A narrative review of an uncommon condition. Ann Med 2016; 48:293-9. [PMID: 27068390 DOI: 10.3109/07853890.2016.1168936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Small cell carcinoma (SCC) of the prostate is an uncommon condition; there are very few cases in which presenting symptoms are consistent with Cushing Syndrome (CS). We report a new case in which CS triggers the suspicion of an SCC of the prostate and a review of the published cases of SCC of the prostate presenting with CS. The origin of these neoplasms is still unclear. It may be suspected when laboratory features appear in patients diagnosed with prostatic adenocarcinoma which becomes resistant to specific therapy. SCC usually occurs after the 6th decade. Patients suffering SCC of the prostate presenting with CS usually present symptoms such as hypertension, hyperglycemia, alkalosis or hypokalemia; cushingoid phenotype is less frequent. Cortisol and ACTH levels are often high. Prostatic-specific antigen levels are usually normal. CT scan is the preferred imaging test to localize the lesion, but its performance may be improved by adding other tests, such as FDG-PET scan. All patients have metastatic disease at the time of diagnosis. Lymph nodes, liver and bone are the most frequent metastases sites. Surgery and Ketokonazole are the preferred treatments for CS. The prognosis is very poor: 2- and 5-year survival rates are 27.5 and 14.3%, respectively. Key messages When a patient presents with ectopic Cushing Syndrome but lungs are normal, an atypical localization should be suspected. We should suspect a prostatic origin if Cushing Syndrome is accompanied by obstructive inferior urinary tract symptoms or in the setting of a prostatic adenocarcinoma with rapid clinical and radiological progression with relatively low PSA levels. Although no imaging test is preferred to localize these tumors, FDG-PET-TC can be very useful. Hormone marker scintigraphy (e.g. somatostatin) could be used too. As Cushing Syndrome is a paraneoplastic phenomenon, treatment of the underlying disease may help control hypercortisolism manifestations. These tumors are usually metastatic by the time of diagnosis. They have very poor prognosis.
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Affiliation(s)
| | - Beatriz Losada-Vila
- b Department of Medical Oncology , Hospital Universitario de Fuenlabrada , Madrid , Spain
| | | | | | - Juan Carlos Tardío
- c Department of Pathology , Hospital Universitario de Fuenlabrada , Madrid , Spain
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3
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Marchevsky AM, Wick MR. Diagnostic difficulties with the diagnosis of small cell carcinoma of the lung. Semin Diagn Pathol 2015; 32:480-8. [DOI: 10.1053/j.semdp.2015.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Hingorani R, Young J, Alweis R. Mixed adenocarcinoma and neuroendocrine prostate cancer: a case report. J Community Hosp Intern Med Perspect 2014; 4:25176. [PMID: 25432647 PMCID: PMC4246144 DOI: 10.3402/jchimp.v4.25176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/02/2014] [Accepted: 09/10/2014] [Indexed: 11/25/2022] Open
Abstract
Background Neuroendocrine prostate cancer is rare but lethal. It is one of the most common extra pulmonary manifestations of small cell cancer. Case presentation Here we present a case report of a 53-year-old male who presents with a mixed adenocarcinoma and neuroendocrine prostate tumor on a background of previously normal prostate-specific antigen (PSA). His initial symptoms prior to diagnosis included decreased urine output and acute kidney injury (AKI). Conclusion Neuroendocrine tumor does not elevate the PSA level and hence is often a late finding with a poor prognosis. Special staining on histopathogy is required to reveal this diagnosis.
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Affiliation(s)
- Rittu Hingorani
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - Jessica Young
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - Richard Alweis
- Department of Medicine, Reading Health System, West Reading, PA, USA; Jefferson Medical College, Philadelphia, PA, USA;
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5
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Small Cell (Neuroendocrine) Carcinoma of the Prostate: Etiology, Diagnosis, Prognosis, and Therapeutic Implications—A Retrospective Study of 30 Patients From the Rare Cancer Network. Am J Med Sci 2008; 336:478-88. [DOI: 10.1097/maj.0b013e3181731e58] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Abstract
In recent years, attention has focused on the prognostic importance of neuroendocrine differentiation in prostate cancer. Focal neuroendocrine differentiation in prostatic adenocarcinoma is a frequent finding. Though controversial, the prevalence of neuroendocrine cells has been correlated with higher-grade malignancy and poor prognosis. As with other small cell tumors, production of ectopic neuropeptides has been reported. The rarity of the disease has precluded prospective randomized trials. Therapeutic regimens have mainly been modeled after those for small cell lung carcinoma. Here we review the literature to identify potential diagnostic, therapeutic, and prognostic factors. Evident from this review is the necessity for further research in the biology of small cell carcinoma progression, in order to improve therapy.
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Affiliation(s)
- Jeffrey S Palmgren
- Division of Urology, Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA
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Viana Miguel MM, García-Plata Polo E, Vidal Doce O, Aldea Martínez J, de la Plaza Galindo M, Santamaría García JL. [Oat cell carcinoma of the common bile duct]. Cir Esp 2006; 80:43-5. [PMID: 16796953 DOI: 10.1016/s0009-739x(06)70915-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Oat cell tumors in the common bile duct are extremely rare. We describe the case of a 76-year-old man with skin and mucous jaundice of 15 days' duration without constitutional syndrome. A tumor was diagnosed in the mid portion of the common bile duct. After surgical resection, pathological analysis revealed small-cell (oat cell) carcinoma. The treatment of these tumors is multidisciplinary. Surgery is followed by chemo- and radiotherapy.
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Affiliation(s)
- M Mar Viana Miguel
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Yagüe, Burgos, España
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Ketata S, Ketata H, Fakhfakh H, Sahnoun A, Bahloul A, Boudawara T, Mhiri MN. Pure primary neuroendocrine tumor of the prostate: a rare entity. Clin Genitourin Cancer 2006; 5:82-4. [PMID: 16859584 DOI: 10.3816/cgc.2006.n.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
An extrapulmonary neuroendocrine tumor arising in the prostate gland has been described in several case series; however, pure and primary prostatic neuroendocrine tumors are very rare, their biologic behavior is not yet well known, and there are only a few reports in the literature describing the clinical features and management of this neoplasm. This article presents the clinicopathologic findings of 2 patients presenting with this disease. The published reports of primary pure neuroendocrine prostate tumors are discussed.
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Affiliation(s)
- Sabeur Ketata
- Department of Urology, CHU Habib Bourguiba, Rue Majida Boulila, Sfax, Tunisia.
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9
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Sereno Moyano M, de Castro Carpeño J, Castelo Fernández B, González Barón M. [Intracardiac metastasis in prostate microcytic carcinoma, with regard to a case]. Rev Clin Esp 2005; 205:359. [PMID: 16029768 DOI: 10.1157/13077127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Venkatesh PK, Motwani B, Sherman N, Ying SC, Tilahun E, Garon JE, Feldman L. Metastatic Pure Small-Cell Carcinoma of Prostate. Am J Med Sci 2004; 328:286-9. [PMID: 15545846 DOI: 10.1097/00000441-200411000-00009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Extrapulmonary small-cell carcinoma arising in the prostate gland has been described in several case series and case reports. However, pure small-cell carcinoma of the prostate is rare, and there are only a few reports in literature describing the clinical features and management of this neoplasm. These tumors are highly aggressive and commonly manifest with visceral metastasis at the time of diagnosis. We report a case of metastatic pure prostatic small-cell carcinoma and an associated paraneoplastic polyneuropathy.
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Affiliation(s)
- Prasanna Kumar Venkatesh
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science/The Chicago Medical School and Mount Sinai Hospital Medical Center, Chicago, IL 60608, USA
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11
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Abstract
The vast majority of prostatic tumors developing in adult males are adenocarcinomas. For the most part, variations in histology have not received specific designations and, from a practical approach, have had any specific prognostic implications handled through application of the Gleason grading system. Nonetheless, some of the adenocarcinoma variants have specific clinical features and differential diagnoses. Furthermore, there has been some controversy regarding the appropriate application of the Gleason grading scheme in these tumors. In addition, there are carcinomas that are in fact not adenocarcinomas and that should be kept as distinct entities. In this paper, the histologic variants of adenocarcinoma are reviewed with emphasis on clinicopathologic features and the clinical relevance of these subtypes. Other carcinomas that occur in the prostate gland are also discussed again with a focus on the clinicopathologic characteristics.
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Affiliation(s)
- David J Grignon
- Department of Pathology, Harper University Hospital and Wayne State University School of Medicine, Detroit, MI 48201, USA.
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12
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Alapont Alacreu JM, Montaner Ramírez MJ, Pontones Moreno JL, Valls Blasco F, Vera-Sempere FJ, Jiménez-Cruz JF. [Small cell carcinoma of the prostate]. Actas Urol Esp 2002; 26:585-8. [PMID: 12448178 DOI: 10.1016/s0210-4806(02)72833-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pure small cell carcinoma of the prostate is rare (less than 1% of all prostatic neoplasm). As a result there are few reports in the literature that describe the salient features and appropriate management of this cancer (less than 200 cases reported). Small cell carcinomas of the prostate are a heterogeneous group of tumors, a number of them have neuroendocrine differentiation and are highly aggressive, commonly with visceral metastases at time of diagnosis. Complete temporary remission has been reported with chemotherapy but this tumor has a poor prognosis. The median overall survival from the time of diagnosis is between 5-17.5 months. We report 2 new cases of small cell carcinoma of the prostate and a review of the literature.
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