Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

A
B
Fig. 3.84 Small cell carcinoma. A Note extensive necrosis. B Typical cytological appearance of small cell carcinoma.
term "carcinoid-like tumours" has been
used to refer to a variety of miscellaneous
entities, most of which refer to
ordinary acinar adenocarcinoma of the
prostate with an organoid appearance
and focal neuroendorcrine immunoreactivity.
Small cell carcinoma
Clinical features
Many patients have a previous history of
a hormonally treated acinar adenocarcinoma.
As the small cell carcinoma component
predominates, serum PSA level
falls and may be undetectable. While
most small cell carcinomas of the
prostate lack clinically evident hormone
production, they account for the majority
of prostatic tumours with clinically evident
ACTH or antidiuretic hormone production.
Histopathology
Small cell carcinomas of the prostate histologically
are identical to small-cell carcinomas
of the lung {2210,2600}. In
approximately 50% of the cases, the
tumours are mixed small cell carcinoma
and adenocarcinoma of the prostate.
Neurosecretory granules have been
demonstrated within several prostatic
small cell carcinomas. Using immunohistochemical
techniques small cell components
are negative for PSA and PAP.
There are conflicting studies as to
whether small cell carcinoma of the
prostate is positive for thyroid transcription
factor-1 (TTF-1), in order to distinguish
them from a metastasis from the
lung {37,1969}.
Prognosis
The average survival of patients with
small cell carcinoma of the prostate is
less than a year. There is no difference in
prognosis between patients with pure
small cell carcinoma and those with
mixed glandular and small cell carcinoma.
The appearance of a small cell component
within the course of adenocarcinoma
of the prostate usually indicates an
aggressive terminal phase of the disease.
In a review of the literature of genitourinary
small cell carcinoma, whereas
cisplatin chemotherapy was beneficial
for bladder tumours, only surgery was
prognostic for prostate small cell carcinomas
{1587}. While this study concluded
that hormonal manipulation and systemic
chemotherapy had little effect on
the natural history of disease in the
prostate, the number of patients were
small and others suggest to treat small
cell carcinoma of the prostate with the
same combination chemotherapy used
to treat small cell carcinomas in other
sites {75,2254}.
208 Tumours of the prostate