Case studyTransformation of prostatic adenocarcinoma to well-differentiated neuroendocrine tumor after hormonal treatment☆
Introduction
Neuroendocrine (NE) cells are a minute subset of specialized cells in the prostate glands that account for less than 0.5% of all epithelial cells; however, they produce a variety of peptide hormones and regulate cell proliferation, apoptosis, metabolism, angiogenesis, and other biological functions in the prostate [1], [2], [3]. On routine hematoxylin and eosin (H&E) examination, NE cells are difficult to distinguish from other epithelial cells in the prostate except for those with Paneth-like features or granular eosinophilic cytoplasm. NE cells are usually recognized by immunoreactivity for NE markers, such as synaptophysin, chromogranin, and CD56 [3]. Although most prostate cancers are composed of adenocarcinoma, pure or de novo NE tumors are extremely rare in the prostate [4], [5]. However, on immunohistochemical analysis, most prostate cancers show rare NE cells that are scattered in the adenocarcinoma [1], [2], [3]. Several studies have found that NE differentiation is enhanced in prostate cancer when patients undergo androgen-deprivation treatment (ADT) [6], [7]. Herein we report a unique case of prostate cancer that underwent a complete transformation from conventional adenocarcinoma to carcinoid-like, well-differentiated NE tumor shortly after ADT.
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Case report
A 59-year-old man initially presented with gross hematuria, but the clinical evaluation, including cystoscopy and computed tomographic urogram, was unremarkable. Four years later, he developed lower urinary tract symptoms with urinary retention, which required the placement of a Foley catheter. Cystoscopic examination revealed a small papillary tumor in the prostatic urethra, which was resected. Microscopically, the lesion was composed of large cribriform atypical glands with focal papillary
Discussion
Although NE cells can be demonstrated in most prostate cancers by immunohistochemistry, the origin of NE cells in prostate cancer remains uncertain. It has been hypothesized that they may originate from the pluripotent stem cells similar to the NE cells in the normal prostate [2], but other researchers proposed separate origins of NE cells in benign and neoplastic prostate glands based on the different gene expression [1], [3]. For instance, NE cells in prostate cancer express α-methyl-
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Cited by (7)
Neuroendocrine differentiation in castration resistant prostate cancer. Nuclear medicine radiopharmaceuticals and imaging techniques: A narrative review
2019, Critical Reviews in Oncology/HematologyCitation Excerpt :These NE cells, therefore do not derive from normal NE cells, and should be defined as ‘NE-like PC cells’ (Yuan et al., 2007; Cerasuolo et al., 2015; Noble et al., 2018). To date, a growing body of evidence in the literature supports the idea that the onset of NED from conventional prostate cancer is associated with systemic treatments (Miyoshi et al., 2001; Tanaka et al., 2001; Beltran et al., 2012; Gilani et al., 2017; Wang et al., 2018; Nouri et al., 2017). This transformation arises because of lineage plasticity.
Evolving concepts in prostatic neuroendocrine manifestations: from focal divergent differentiation to amphicrine carcinoma
2019, Human PathologyCitation Excerpt :Recently, a case report of a tumor fulfilling the criteria of a well-differentiated NE tumor (carcinoid tumor) was reported in a patient with conventional adenocarcinoma treated with androgen-deprivation therapy [54]. It is not clear whether this tumor would represent a second primary tumor or transdifferentiation from the original prostatic adenocarcinoma [54]. Data on the molecular pathogenesis of well-differentiated NE tumors are scarce.
Prostate adenocarcinoma in a young patient with multiple endocrine neoplasia 2B
2018, Annales d'EndocrinologiePrimary Well-Differentiated Neuroendocrine Tumor/Carcinoid of the Prostate: Case Report and Review of Literature
2024, International Journal of Surgical PathologyGenitourinary neuroendocrine neoplasms
2020, The Spectrum of Neuroendocrine Neoplasia: A Practical Approach to Diagnosis, Classification and TherapyLineage plasticity in cancer: a shared pathway of therapeutic resistance
2020, Nature Reviews Clinical Oncology
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Disclosures: None.