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1 病案报告 患者男,41岁,土家族,司机。以尿急、尿频、尿痛、排尿困难3月余,尿潴留40天收住我科。于3月前无诱因渐感尿急、尿频、尿痛,未予诊治,在饮酒后突感排尿困难,尿道灼痛,在当地医院诊为“急性前列腺炎”,行“前列腺药物注射”治疗半月效果差,需留置尿管,诊为“前列腺脓肿,左后叶严重”,转入外院,经行穿刺活检及MRI诊为“前列腺炎,左后叶血肿”,治疗效果差。后转入我科行“手术探查”,切开膀胱见膀胱颈尿道内口处有直径6cm半球形肿块,呈鱼肉样、质韧、表面溃烂、渗血,并与盆腔周围组织固定,肿块无法切除,取部分组织活检,留置导尿管及膀胱造瘘管,关腹术毕。病检报告前列腺低分化肉瘤。术后化疗及免疫治疗,1月后肿瘤双肺及骨盆转移、破坏,右肾积水。2月后恶病质全身衰竭死亡。 2 讨论 本例患者之所以多次误诊,甚至借助先进影像学检查及穿刺活检亦未避免误诊,主要原因分析如下: 2.1 前列腺肉瘤少见 stafford(1829)首先报道本病,曹晨涛(1930)报告国内首例。本病任何年龄都可发病,但多见于青年人及儿童,约30％发生于10岁以内,75％发生于40岁以内。但近年来也呈上升趋势,故临床医生很少考虑,甚至辅助检查也多将前列腺弥漫病变考虑为炎症浸润。
1 medical record patient male, 41 years old, Tujia, driver. Urinary urgency, frequent urination, dysuria, dysuria more than 3 months, urinary retention 40 days to receive our department. In 3 months ago there was no incentive to urgently urinary urgency, frequent urination, dysuria, no diagnosis and treatment, after drinking the sudden sensation dysuria, urinary burning, at the local hospital diagnosed as “acute prostatitis” line “Prostate drug injection” treatment Half bad effect, need to be placed catheter, diagnosed as “prostate abscess, left posterior lobe,” transferred to the outer hospital, biopsy and line diagnosis of “prostatitis, left posterior hematoma,” poor treatment. After the transfer into our branch “Surgical exploration”, cut the bladder to see the bladder neck urethra diameter 6cm hemispherical lumps were fish-like, tough quality, surface ulceration, bleeding, and the pelvic tissue around the fixed mass can not Excision, take part of the biopsy, indwelling catheter and bladder fistula, closing abdominal surgery completed. Disease reports of poorly differentiated prostate sarcoma. Postoperative chemotherapy and immunotherapy, lung cancer and pelvic metastasis, destruction, right hydronephrosis after 1 month. 2 months after the cachexia died of systemic failure. 2 Discussion The reason why the patient misdiagnosed many times, and even with advanced imaging and biopsy did not avoid misdiagnosis, the main reasons are as follows: 2.1 Prostate sarcoma rare stafford (1829) first reported the disease, Cao Chen Tao (1930) reported the first example. The disease can occur at any age, but more common in young people and children, about 30% occurred within 10 years of age, 75% occurred in 40 years of age. But in recent years also showed an upward trend, so clinicians seldom consider, and even assistant examinations are more considered as diffuse lesions of the prostate inflammatory infiltration.