A brief literature review on an unusual prostate cancer - a case presentation

Abstract

Background Small-cell neuroendocrine (NE) carcinoma accounts for only 1 % of all prostate cancers. However, it represents a distinct clinicopathological category and can pose certain difficulties to reporting pathologists in terms of determining primary or secondary status, and appropriate interpretation of immunohisto-chemical stains particularly in metastatic lesions. Case presentation Morphological and immunohistochemical (synaptophysin and thyroid-transcrition-factor-1 or TTF-1 positive; prostatic specific antigen negative) profiles of a metastatic small-cell NE carcinoma of prostate in a patient previously treated with antiandrogen and radiotherapy are presented. Literature review Immunohistochemical staining for all NE markers may be negative in 10% of cases, making morphological features the main diagnostic criteria. Prostatic-specific markers are negative in the majority of cases, which proves to be a diagnostic challenge. TTF-1 is not useful to exclude secondary disease from lung origin. The fact that many patients have a previous history of a hormonally treated prostatic adenocarcinoma of usual acinar type is important for correct diagnosis. Evidence suggests that NE carcinoma cells ‘transdifferentiate’ from non-NE cancer cells, and that among inducers of the process androgen deprivation is the most significant. Patients frequently present with metastatic disease to bone, liver, lung, and lymph nodes, and generally do not respond to hormonal or radiation therapy.