PMC3576181_01
(A) Pelvic MRI obtained prior to the androgen-ablation therapy demon strating the presence of an invasive prostatic tumor and numerous large metastatic LN lesions. (B) Pelvic MRI following the androgen-ablation therapy demonstrating a locally advanced prostatic tumor, which projected into the bladder and had reduced LN swelling. (C) Pelvic MRI following the combination treatment involving EBRT and intra-arterial infusion chemotherapy demonstrating that the prostatic tumor had markedly diminished. LN, lymph node; EBRT, external-beam radiotherapy.
OL-05-03-0793-g00.jpg
PMC3576181_01_OL-05-03-0793-g00.jpg
f1-ol-05-03-0793
Abdominal ultrasonography, transrectal ultra-sonography, computed tomography (CT), magnetic resonance imaging (MRI; Fig. 1A) and transrectal biopsy (Fig. 2A) were performed. In October 2007, MRI (Fig. 1B) detected a large tumor extending from the prostate to the bladder and the patient's PSA value was 0.151 ng/ml at that time. The tumor volume was reduced in MRI (Fig. 1C) and therefore, the urethral catheter was removed in April 2008 and the patient had no urinary symptoms.
(A) Transrectal biopsy produced a diagnosis of poorly differentiated adenocarcinoma with small cell NE carcinoma. HE staining produced an initial diagnosis of Gleason pattern 5b poorly differentiated adenocarcinoma (magnification, x100). (B) PSA staining revealed that PSA-positive and -negative cells were intermixed in the biopsy sample (magnification, x100). HE, hematoxylin and eosin; NE, neuroendocrine; PSA, prostate-specific antigen.
OL-05-03-0793-g01.jpg
PMC3576181_01_OL-05-03-0793-g01.jpg
f2-ol-05-03-0793
Subsequently, an additional immunohistochemical examination of the transrectal biopsy tissue was performed, which identified carcinoma cells showing the same results as the transurethral biopsy tissue cells with the exception of PSA, which revealed the intermingling of PSA positive and negative cells (Fig. 2B).
(A) Transurethral biopsy produced a diagnosis of small cell NE carcinoma. HE staining revealed that these carcinoma cells had similar morphological features to the transrectal biopsy tissue carcinoma cells (magnification, x100). (B) None of the tumor cells were positively stained for PSA (magnification, x100). NE, neuroendocrine; HE, hematoxylin and eosin; PSA, prostate-specific antigen.
OL-05-03-0793-g02.jpg
PMC3576181_01_OL-05-03-0793-g02.jpg
f3-ol-05-03-0793
A transurethral biopsy was performed (Fig. 3A) and the patient was diagnosed with PSCNC that occurred following the androgen-ablation therapy. An immunohistochemical examination of the biopsy tissue revealed that the tumor cells were negative for PSA (Fig. 3B), neuron-specific enolase (NSE), chromogranin A and CD56, but positive for synaptophysin.