以继发性前列腺肿瘤为首发表现的浆细胞样 尿路上皮癌：诊断误区与文献回顾

Plasmacytoid Urothelial Carcinoma with Initial Presentation as a Secondary Prostatic Tumor: Diagnostic Pitfalls and Literature Review

摘要: 背景：浆细胞样尿路上皮癌是一种罕见且侵袭性强的尿路上皮癌组织学亚型，常因形态学特征与其他恶性肿瘤相似而被误诊。其累及前列腺的继发性表现极为罕见，这给诊断带来了挑战。病例报告：本文报告一例58岁男性浆细胞样尿路上皮癌患者，其临床表现以前列腺肿块为主。初次活检提示为低分化癌，考虑原发性前列腺癌可能。免疫组化检测显示GATA3和CD138阳性，但PSA和PSAP阴性，证实为尿路上皮来源。影像学检查显示膀胱颈及前列腺弥漫性浸润。患者接受了根治性膀胱前列腺切除术并辅以化疗。讨论：本病例凸显了浆细胞样尿路上皮癌与高级别前列腺癌鉴别诊断中的误区，并强调了免疫组化分析对准确诊断的重要性。通过回顾2010至2024年间发表的病例，总结其临床病理特征、影像学表现及治疗结果。早期识别该变异型可避免误诊并改善预后评估。结论：浆细胞样尿路上皮癌侵袭前列腺首发表现可与原发性前列腺癌相似。病理学家和泌尿外科医师需充分认识其独特的免疫组化模式和影像学特征。将组织病理学与影像学及临床数据相结合，可确保准确诊断并优化治疗决策。

Abstract: Background: Plasmacytoid urothelial carcinoma (PUC) is a rare and highly aggressive histological variant of urothelial carcinoma, often misdiagnosed due to its morphological similarity to other malignancies. Its secondary presentation involving the prostate is exceedingly rare, posing significant diagnostic challenges. Case Report: This report describes a 58-year-old male with PUC whose primary clinical manifestation was a prostatic mass. Initial biopsy suggested a poorly differentiated carcinoma, raising suspicion for primary prostatic adenocarcinoma. Immunohistochemical analysis revealed positivity for GATA3 and CD138, but negativity for PSA and PSAP, confirming a urothelial origin. Imaging studies demonstrated diffuse infiltration of the bladder neck and prostate. The patient underwent radical cystoprostatectomy followed by adjuvant chemotherapy. Discussion: This case highlights the diagnostic pitfalls in distinguishing PUC from high-grade prostate cancer and emphasizes the critical role of immunohistochemical analysis for accurate diagnosis. By reviewing cases published between 2010 and 2024, we summarize their clinicopathological features, imaging findings, and treatment outcomes. Early recognition of this variant can prevent misdiagnosis and improve prognostic assessment. Conclusion: PUC presenting with primary prostatic involvement can mimic primary prostate cancer. Pathologists and urologists must be aware of its distinctive immunohistochemical profile and imaging characteristics. Integrating histopathology with imaging and clinical data ensures accurate diagnosis and optimizes treatment decision-making.