A CASE OF PAPILLARY ADENOCARCINOMA OF THE PROSTATE

Abstract

Papillary adenocarcinoma of the prostate was first described by Melicow and Pachter, who thought that it was derived from the median Müllerian remnant. Subsequently, Dube et al. reported papillary adenocarcinoma which was derived from the prostatic duct. It is not easy to identify the origin of papillary variety of prostatic adenocarcinoma but it is important, since this lesion may have a natural history and biological behavior different from that of usual prostatic carcinoma.
Our case is a 77-year-old merchant who sought relief for acute urinary retention. The prostate was enlarged, firm and partly indurated. Serum acid phosphatase level was normal and needle biopsy of the indurated lobe revealed only benign prostatic hyperplasia. A suprapubic prostatectomy was performed without difficulty. The gland was enucleatced easily.
The specimen submitted for histological examination consisted in 16 gm, prostatic tissue which was grossly normal with usual nodular hyperplasia. Histologically it was mostly nodular hyperplasia but focally there existed areas of papillary adenocarcinoma of moderate cellular atypism. A pattern of the carcinoma was strikingly different from that of usual carcinoma of the prostate. It was consisted of large columnar type of cells with hyperchromatism which were arranged in bands with infolding and papillary formations. Nuclei were relatively large and seen at the bottoms of cells. They had one or two distinct nucleoli.
The patient's postoperative course was uneventful.
One and half years postoperatively obstruction appeared again and under diagnosis of a recurrence of prostatic carcinoma TURP and castration were performed. At that time there was no evidence of metastasis and serum acid phosphatase was normal.
Stilbestrol has been prescribed for these 5 years after the second operation. The patient is well and free of metastasis. In this case antiandrogenic therapy was not thought to be harmful.