Sarcomatoid Carcinoma of the Prostate: A Study of 42 Cases

ArticleinAmerican Journal of Surgical Pathology 30(10):1316-21 · November 2006with32 Reads
DOI: 10.1097/01.pas.0000209838.92842.bf · Source: PubMed
Abstract
Unlabelled: Sarcomatoid carcinoma of the prostate is a rare type of prostatic cancer. With the exception of 1 study, the morphologic features and patient outcomes have been reported only in relatively small case series and individual reports. We examined transurethral resection, needle biopsy, and radical prostatectomy specimens from 42 patients with sarcomatoid carcinoma of the prostate, all of which were received in consultation. Clinical information on 32 patients was obtainable. Five patients were lost to follow-up and information on the 5 remaining patients could not be obtained. Prior prostatic adenocarcinoma: The majority of patients (n=21; 66%) had a prior history of acinar adenocarcinoma of the prostate. Of the 14 men with available data, reported Gleason scores were 6 (n=7), 8 (n=4), and 10 (n=3). Of the remaining patients for whom this information was known, 11 patients presented with de novo sarcomatoid carcinoma. The time between the original diagnosis of acinar adenocarcinoma and diagnosis of sarcomatoid carcinoma ranged from 6 months to 16 years (mean 6.8 y). Concurrent adenocarcinoma: The majority of patients demonstrated a concurrent high grade acinar carcinoma of Gleason score 7 (n=3), 8 (n=9), 9 (n=10), and 10 (n=10). A subset of patients contained an admixed ductal adenocarcinoma (n=4), small cell carcinoma (n=3), squamous cell carcinoma (n=3), or other unusual pattern of prostate carcinoma (n=3). In 1 case, the diagnosis was based on immunohistochemical evidence of epithelial differentiation along with the history of prior adenocarcinoma. Morphology of the sarcomatoid component: The percentage of sarcomatoid growth ranged from 5% to 99% (mean 65%). Bizarre atypia with giant cells was present in 55% of cases. Admixed heterologous elements were identified in 10 cases (29%), including osteosarcomatous (n=7), chondrosarcomatous (n=5), and rhabdomyosarcomatous (n=2) elements. Of the 12 cases with received immunostains of the sarcomatoid component, 5/7 cases were at least focally positive for cytokeratin, 1/1 case was focally positive for Cam5.2, and 3/6 cases were focally positive for prostate acid phosphatase. The sarcomatoid component did not demonstrate immunoreactivity for prostate-specific antigen in 8 cases. Prognosis: approximately half of all patients developed metastatic disease either at time of presentation or subsequently. Of patients with meaningful follow-up, 6/7 died within 1 year of the diagnosis of sarcomatoid carcinoma; 20 were alive yet with very short follow-up (median 1 y; mean 2.3 y). Kaplan-Meier analysis revealed that the actuarial risk of death at 1 year after diagnosis of sarcomatoid carcinoma was 20%. No correlation was identified between patient survival and morphologic features, before radiation or hormone therapy, or concurrent high-grade prostate cancer. Sarcomatoid carcinoma demonstrates diverse spindle and epithelial cell morphologies. The sarcomatoid component often has heterologous elements and, in 1 case, no epithelial component was seen on hematoxylin and eosin-stained sections. The epithelial component is typically high-grade acinar adenocarcinoma, yet other aggressive tumor subtypes such as ductal adenocarcinoma and small cell carcinoma may also be seen. Sarcomatoid carcinoma is an aggressive form of prostate cancer, the prognosis of which is dismal regardless of other histologic or clinical findings.
    • "Primary carcinosarcoma of the prostate is a rare entity, representing approximately 0.1% of all prostatic neoplasms. Nearly half of the reported patients have a history of prostatic adenocarcinoma [1, 2], with the majority of these having received external beam radiation or brachytherapy [3, 4] . Serum levels of prostate specific antigen (PSA) are most often not elevated. "
    [Show abstract] [Hide abstract] ABSTRACT: Carcinosarcoma of the prostate is an exceedingly rare form of prostate cancer. Prognosis is poor, and the observed biological behavior of these tumors is to be very aggressive irrespective of histologic variants. Some authors speculate that the increasing use of external beam radiation therapy and brachytherapy in the treatment of prostatic adenocarcinomas may raise the incidence of carcinosarcoma. We present the case of a 71 year-old Caucasian male with a history of prostatic adenocarcinoma treated with brachytherapy seven years ago. The patient developed progressive genitourinary symptoms leading to impotence and severe urinary obstruction. This was followed by cystoprostatectomy and incidental pathology diagnosis of carcinosarcoma of the prostate. Fluorescent in situ hybridization study for amplification of the c-Myc gene, frequently seen in radiation-induced sarcomas, was negative. Carcinosarcomas of the prostate show general similarities of clinicopathologic features regardless of histologic variants or etiology. Our case, as well as the accompanying review of the literature, highlights the complexity of diagnosis of prostatic carcinosarcoma, as well as its continued poor prognosis. Due to the limited number of available cases, it is not possible to conclude at this time whether or not there is a causative association of this tumor with prior radiation therapy of the prostate.
    Full-text · Article · Jan 2016
    • " It had been suggested by Hansel and Epstein [3] that surgical resection of the curative tumours, adjuvant chemotherapy, and / or radiotherapy, together with palliative attempts in patients with advanced staged disease, would constitute the general approach to the management of sarcomatoid carcinoma of the prostate gland. In 1993, Lauwers et al. [9] stated that carsinosarcoma of the prostate gland is a biphasic which contain adenocarcinoma (ACA) and recognizable sarcomatous components. "
    Article · Jan 2015 · Oncology letters
    • "Mixed prostatic carcinoma is exceedingly rare and its pathogenesis is not clear (4). Previous studies have demonstrated that hormonal treatment and radiotherapy may lead to changes in the nature of the tumor (5). In the present study, the patient was diagnosed with adenocarcinoma, ASC and SC following hormonal treatment, and the patient’s condition progressively deteriorated despite active treatment. "
    [Show abstract] [Hide abstract] ABSTRACT: Adenosquamous carcinoma (ASC) and sarcomatoid carcinoma (SC) of the prostate are rare, but highly aggressive tumors. The occurrence of mixed carcinomas in the prostate is even more rarely reported. The present study reports the case of a 62-year-old male who was diagnosed with prostatic adenocarcinoma accompanied by multiple bone metastases, as shown by a needle biopsy and skeletal computed tomography scan. The patient was treated with hormonal therapy, but thereafter, specimens from a transurethral resection of the prostate (TURP) were found to be composed of three histologically distinct elements: ASC, SC and adenocarcinoma. The level of p53 was evaluated by immunohistochemistry in detail, and it was found that this was significantly increased in the TURP samples compared with the needle biopsy samples. The abnormal level of p53 was likely associated with the prognosis of the patient; the patient succumbed to prostate carcinoma two months after the confirmation of the diagnosis.
    Full-text · Article · Nov 2014
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