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目的探讨前列腺囊腺瘤的临床病理特点、诊断与鉴别诊断、治疗与预后。方法分析1例前列腺囊腺瘤伴高级别上皮内瘤变的临床特征、影像学表现、组织学形态及免疫表型,并复习相关文献。结果患者男性,69岁,排尿排便不畅1年。MRI示盆腔巨大团块状囊实性信号,多发条索状分隔,分隔上见1.6 cm×1.4 cm大小、DWI高信号、ADC低信号、可强化的软组织影。术中见肿瘤与前列腺紧密粘连,剖开肿瘤呈多房囊性,囊壁大部分光滑,局部颗粒状,1.5 cm×1 cm大小,厚0.3 cm~0.4 cm。病理检查囊壁被覆PSA(+)、P504S(-)的立方或柱状上皮,颗粒状区域呈稍密集乳头状,细胞有异型,核仁小至中等大小,Ki-67增高,p53阳性。结论前列腺囊腺瘤是前列腺来源的罕见良性肿瘤,易误诊为苗勒管囊肿、囊状淋巴管瘤、前列腺囊肿等。肿瘤可伴发高级别上皮内瘤变,甚至癌变,病理检查需结合影像学表现充分取材。治疗以手术完整切除为主,伴高级别上皮内瘤变或癌变者预后有待长期观察。
Objective To investigate the clinicopathological features, diagnosis and differential diagnosis, treatment and prognosis of prostatic cystadenoma. Methods One case of prostatic cystadenoma with high grade intraepithelial neoplasia was analyzed for clinical features, imaging findings, histological features and immunophenotypes, and review of relevant literature. Results Male patients, 69 years old, poor urination defecation 1 year. MRI showed pelvic massive massive solid signal, multiple cord separation, see the size of 1.6 cm × 1.4 cm separation, DWI high signal, ADC low signal, enhanced soft tissue shadow. See the tumor surgery and prostate tight adhesions, open the tumor was multi-cystic nature, the wall most of the smooth, local granular, 1.5 cm × 1 cm size, thickness 0.3 cm ~ 0.4 cm. Pathological examination The wall of the capsule was covered with cubes or columnar epithelium of PSA (+) and P504S (-). The granular area was slightly papillary. The cells were irregular. Nucleoli were small to medium in size. Ki-67 was increased and p53 was positive. Conclusions Prostate cystadenoma is a rare benign tumor of prostate origin. It is easily misdiagnosed as Müllerian cyst, cystic lymphangioma and prostatic cyst. Tumors can be associated with high-grade intraepithelial neoplasia, or even cancer, pathological examination to be combined with imaging findings fully drawn. Treatment of complete removal of the main surgery, with high-grade intraepithelial neoplasia or cancer prognosis remains to be observed.