UROPATHOLOGY SQUAMOUS CELL CARCINOMA OF PROSTATE DEBA P. SARMA, M.D. THOMAS G. WEILBAECHER, M.D. TIMOTHY D. MOON, M.D. From the Department of Pathology, Veterans Administration Medical Center, Louisiana State University Medical School, and Tulane University Medical School, New Orleans, Louisiana ABSTRA C T--A primary squamous cell carcinoma occurring in the prostate of a sixty-nine-year-~ man is described. A radical excision that included cystoprostatectomy, total penectomy, scroti tomy, pubic symphysiectomy, and abdominoperineal resection of rectum was done. The patii died of systemic metastases six months after diagnosis. Review of the literature suggests that sucJ cancer of the prostate is rare, highly aggressive, and responds poorly to any mode of therai Histogenesis of this tumor remains controversial; however, it probably does not originate from ! prostatic acinar cells. Primary squamous cell carcinoma of the pros- tate is rare. It appears to differ from common prostatic adenoeareinoma in its histogenesis, clinical course, and therapeutic response. In a review of 481 eases of prostatic car- cinoma seen in the New Orleans VA Hospital's laboratory service over a period of ten years (January 1976 to December 1985), only 1 ease of keratinizing squamous cell carcinoma of the prostate has been found. We report this ease along with a review of the literature with spe- cial attention to the histogenesis of the tumor. Case Report A sixty-nine-year-old black man presented with acute urinary retention. He had under- gone multiple urethroplasties in the past for re- current bulbar urethral strictures. Past history included recurrent urinary tract infections, prostatitis, bladder diverticuli, and chronic py- elonephritis. Physical examination was unre- markable except for a palpable right inguinal lymph node. Cystoscopy revealed an irregular, friable urethral mucosa extending from the bladder neck to the bulbar urethra. There was almost complete obstruction of the prostatic urethra by tumor that a b showed squamous cell eareino the abdomen and pelvis did n~ tra-abdominal spread of the t: chest roentgenogram and rout and serum chemical tests were The patient underwent a stt inguinal lymphadenectomy. T were free of metastatic ear quently the patient underwe~ teration that included a radica tomy with ileal conduit, total bilateral orchiectomy and scr symphysiectomy, and abdomi~ tion of rectum with colostomy. fect was reconstructed with muscle flaps. Gross examination of the rc showed a gray-white, focally [ mor involving the entire prost~ plete obstruction of the prosta tumor had extended into the 1: had projected into the lumen however, the bladder mueosa tumor had also invaded the l tissue. Microscopically, the keratinizing squamous cell care 260 UROLOGY / MARCH 1991 / VOLUME XXXVII, NU : ~
Transcript
UROPATHOLOGY
SQUAMOUS CELL CARCINOMA OF PROSTATE
DEBA P. SARMA, M.D.
THOMAS G. WEILBAECHER, M.D.
TIMOTHY D. MOON, M.D.
From the Department of Pathology, Veterans Administration Medical Center, Louisiana State University Medical School, and Tulane University Medical School, New Orleans, Louisiana
ABSTRA C T--A primary squamous cell carcinoma occurring in the prostate of a sixty-nine-year-~ man is described. A radical excision that included cystoprostatectomy, total penectomy, scroti tomy, pubic symphysiectomy, and abdominoperineal resection of rectum was done. The patii died of systemic metastases six months after diagnosis. Review of the literature suggests that sucJ cancer of the prostate is rare, highly aggressive, and responds poorly to any mode of therai Histogenesis of this tumor remains controversial; however, it probably does not originate from ! prostatic acinar cells.
Primary squamous cell carcinoma of the pros- tate is rare. It appears to differ from common prostatic adenoeareinoma in its histogenesis, clinical course, and therapeutic response.
In a review of 481 eases of prostatic car- cinoma seen in the New Orleans VA Hospital's laboratory service over a period of ten years (January 1976 to December 1985), only 1 ease of keratinizing squamous cell carcinoma of the prostate has been found. We report this ease along with a review of the literature with spe- cial attention to the histogenesis of the tumor.
Case Report
A sixty-nine-year-old black man presented with acute urinary retention. He had under- gone multiple urethroplasties in the past for re- current bulbar urethral strictures. Past history included recurrent ur inary tract infections, prostatitis, bladder diverticuli, and chronic py- elonephritis. Physical examination was unre- markable except for a palpable right inguinal lymph node. Cystoscopy revealed an irregular, friable urethral mucosa extending from the bladder neck to the bulbar urethra. There was almost complete obstruction of the prostatic
u re th ra by tumor that a b showed squamous cell eareino the abdomen and pelvis did n~ tra-abdominal spread of the t: chest roentgenogram and rout and serum chemical tests were
The patient underwent a stt inguinal lymphadenectomy. T were free of metastatic ear quently the patient underwe~ teration that included a radica tomy with ileal conduit, total bilateral orchiectomy and scr symphysiectomy, and abdomi~ tion of rectum with colostomy. fect was reconstructed with muscle flaps.
Gross examination of the rc showed a gray-white, focally [ mor involving the entire prost~ plete obstruction of the prosta tumor had extended into the 1: had projected into the lumen however, the bladder mueosa tumor had also invaded the l tissue. Microscopical ly, the keratinizing squamous cell care
260 UROLOGY / MARCH 1991 / VOLUME XXXVII, NU : ~
0st the entire prostate and prostatic urethra i iymphatie and vascular invasion (Fig. 1). ddfinite site of origin, such as urethra or Urethral duets could be ascertained. Seat- d[ remaining prostatic glands were normal. ii:hnoperoxidase study revealed the presence iirhstate-speeific antigen in the few remain- ~i!ostatie glands but complete absence in the ~ecl'lastie cells. The sections from the bladder
neoplastic cells in the subepithelial tis-
i ith normal overlying urothelium. e patient was discharged one month after
i~tion. Two months later he was admitted ii symptoms of small-bowel obstruction due idhesions. At laparotomy metastatic ear- ~ii:i ima was noted in the liver. Subsequently ~ionary metastases were noted on chest ~i!genogram. During the course of the dis- t h e patient's serum acid phosphatase level :remained normal. The patient died six i!hS after diagnosis or about four months af- i~dical resection.
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Comment
ist of the cancers occurring in the prostate denocarcmomas. Primary squamous cell aoma of the prostate is rare accounting for L0.5 to 1 percent of prost.ate cancers. 2 Be- of the rarity of such tumors as well as the
L~ion in differentiating squamous cell car- aa from squamous metaplasia (commonly '~ing around prostatic infarcts, in chronic i[itis, and after estrogen therapy or radia- iherapy), strict diagnostic criteria such as suggested by Mott 2 should be followed.
[,ia for the diagnosis of primary squamous ~rcinoma are: (1) clearly malignant neo- i judged by invasion, growth pattern, and ~r anaplasia; (2) squamous features of [nization, squamous pearls, and intercel- bridges; (3) lack of glandular differentia- :(~) no prior estrogen therapy; and (5) ab- :o f pr imary squamous cell carcinoma here, particularly in the bladder. Our ease ~filled all the criteria.
i~ ically primary squamous cell carcinoma f b e distinguished from adenocarcinoma
} prostate. Usual presentation is prostatic ~al obstruction or symptoms due to meta- b o n e disease in elderly men. However, ~ i th metastatic disease serum acid phos- ~e level is usually not elevated in squa- ~eell earcinomas~,a in contrast to primary icarcinomas Radiologically, the bone me- !is from prostat ic adenocarc inoma is
FmURE 1. lslands o] keratinizing squamous cell carcinoma have occuppied entire prostate (hema- toxylin eosin, original magnification x 90).
usually osteoblastic compared with the osteoly- tic lesions in cases of metastatic squamous cell carcinoma of the prostate. 2
Squamous cell carcinoma of the prostate is a highly aggressive tumor. Various therapeutic modalities are not very effective in controlling this cancer. Surgical therapy has included total prostatectomy, 4's transurethral prostatic resec- t ion , ~'3,6 and orch iec tomy. 2,~,7 Es t rogen t he r apy ~,4,~ is usually ineffective. Radiation therapy has been used to control the primary disease 3,4 as well as for palliation of bone metas- tasis. 2 Chemotherapy with doxorubicin hydro- chloride (Adriamyein) was met wi th good therapeutic response lasting up to five months in a patient with systemic metastases. 3 Average survival after diagnosis is about fourteen months. 2 Longest survival up to nine years was reported in a patient treated primarily with ra- diation.* In a reported case s radical surgical therapy that included cystoprostatectomy, total urethrectomy, bilateral pelvic node dissections, pubic symphysieetomy, and abdominoperineal resection of rectum was not successful. Perineal recurrence developed, and the patient died six months after surgery.
Histogenesis of squamous cell carcinoma re- mains debatable. Several authors believe that the prostatic urethral urothelium is the origin of squamous cell c a r c i n o m a . 1,6,s G r a y and MarshalP think that squamous cell carcinoma arises from the transitional epithelium of the periurethral ducts. Sieracki 4 has speculated that the basal or the reserve cells of the prostatic acini are the ceils of origin for squamous cell carcinoma. The common acinar columnar ceils
/ MARCH 1991 / VOLUME XXXVII, NUMBER 3 261
may also be the source of squamous cell car- cinoma because they retain the ability for squa- mous differentiation. 2 Many reports describing mixed carcinoma or adenosquamous .carcinoma of the prostate clearly show that common pros- tatic adenocarcinomas may develop foci of squamous carcinoma especially after hormone or radiation therapy. 9-n In two reports the squamous cell carcinoma component was posi- tive for prostate-specific antigen by immuno- peroxidase study indicating that the neoplastic squamous cells were prostatic glandular epithe- lium in origin. 1°,11 In our case, the neoplastic squamous cells were completely negative for prostate-specific antigen suggesting that the cell of origin probably was not the prostatic acini. Whereas the clinical course and therapeutic re- sponse (specifically to hormonal manipulation) of mixed adenosquamous carcinomas are simi- lar to those of prostatic adenoearcinomas, the primary prostatic squamous cell carcinoma is clinically very aggressive with poor response to any therapy. It appears that the histogenesis of pure squamous cell carcinoma of the prostate may be distinctly different from that of adeno- squamous cancers, n
V. A. Medical Cen[i ~ 1601 Perdido Sfr~
New Orleans, Louisiana 70i~ (DR. S A R ~
References
i. Mostofi FK, and Price EB Jr: Tumor,, system, in Atlas of Tumor Pathology, Washington, D.C., Armed Forces Institute o 245-246.
2. Mort LJM: Squamous cell carcinoma o of 2 eases and review of the literature, J Ur
3. Corder MP, and Ciemil GA: Effeetiv, static squamous eel] carcinoma of the prostat Urol 115:222 (1976).
4. Sieracki JC: Epidermoid carcinoma of report of three eases, Lab Invest 4:232 (191
