UROP THoLocY

PROSTATE MUCINOUS ADENOCARCINOMA WITH SIGNET RING CELL YUTAKA UCHIJIMA, M.D. HIROKI ITO MIWAKO TAKAHASHI MOTOAKI YAMASHINA, M.D. From the Departments of Urology and Pathology, Saitama Medical School, Saitama, Japan

~::::)STRACT--Carcinoma exhibiting signet ring cell appearance in the prostatic gland i~ rare./.n example of this rare tumor is presented herein.

th production of mucin in the 1 have been considered rare. ~ribed this type of prostatic car, only about 40 cases have been literature. The present case was imary prostatic carcinoma with mr cells. Using periodic aeid~), alcian blue, and immunohisas of prostatic-specific antigen, ature of the mucin were evalu-

with PAS (Fig. 1B). The mucin ~a~; localized intracellularly. Most of tumor cells were also stained with prostatic-specific antil,~en. The patient underwent hormonal manipulation with ehlormadinone acetate tablets 100 mg/day and subsequently received eherrLotheiapy with pepleomycin for months. Despite aggressive therapy, the disease was prog~e,;sitve. Eventually he died of myocardial m:~arction in nineteen months. Comment

Case Report year-old man was referred to us tonth history of prostatism. nation showed no remarkable ectal digital examination, the lpated as stony hard mass. Roudata including both acid and al:ase values were within normal ~ctal prostatic needle biopsy was Lthe diagnosis of mutinous carde. No metastasis was observed Lgs, and liver, and no extraprosas found. Histologically, the 1 contained loci of solid and tuents of tumor cells with numercells (Fig. 1A). The mueinous se signet ring cells was stained fleian blue (pH = 2.5) but not

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While it has been believed that noi'm,~l prostatic glands secrete no mucin, Foster and Levine~ found muciearmine-positiv,e ~aterial in 68 percent of well-differentiated prostatic carcinoma and Pilcher a found similar materials in 20 per cent of normal glands. In those cases mucin secretion appears to be focal. Whether mucin could be secreted by prostatic adenocarcinoma has been controversial.* In 1979, Elbadawi and his colleagues4 proposed four criteria for establishing the diagnosis of mutinous carcinoma of the prostatic gland: (1) abundant secretion by t u m o r cells of histochemically proved acidic or neutral mucin; (2) sparing or only secondary involvement of prostatic ducts, prostatic urethral urothelium, and uterine masculines; (3) nonpapillary growth with colloid carcinoma pattern; (4) absence of extraprostatic

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FIGURE 1. (A) Biopsy o] prostate shows prostatic carcinoma with numerous signet ring cells. (B) Mucinous material in signet ring cells was stained intensely with alcian blue. (Original magnifications x 200.) primary mucinous carcinoma. However, subsequent investigators emphasized prostatic adenoeareinomas containing signet ring cells should be excluded from the entity of conventional primary prostatic mueinous carcinomas. Furthermore, Epstein and Lieberman 5 stressed that in defining mueinous carcinoma the term should be consistent with definitions of mueinous tumor in other organs, and it should be diagnosed as mutinous carcinoma of the prostatie gland after evaluating at least 25 percent of the tumor reseeted during a single procedure contained lakes of extraeellular muein. With these criteria, re-examination of the published eases shows that many eases are either unacceptable or questionable as mueinous carcinoma of the prostatic gland. After 1981, 2 eases were reported with the diagnosis of primary signet ring cell carcinoma of the prostatic gland. 6,7 Because signet ring cells are complicated by the typical mueinous carcinoma, it may be thought that those earcinoma cells secrete mucin only in the intraeellular area. Still several more eases were defined as primary mueinous carcinoma, which exhibited the characteristic histologie features of the mueinous carcinoma with signet ring cells, s,° The content of the muein of signet ring cells may be divided into three groups: (1) mucoprotein (polysaceharide-protein complexes predominantly protein); (2) mueopolysaecharides (polysaeeharide-protein complexes predominantly carbohydrate); and (3) mueolipid (polysaeeharide-fat). 1° In normal prostatic glands the neutral mueosubstanees were found within the cell, but acid mueosubstanees were not generally found. Therefore Hukill and Vidone H described that stains for acid mueosubstanees 268

(alcian blue stain) may be of value in recog x z , ~ ing prostatic carcinoma in tissue sections, p a r - ~ ticularly in needle biopsies because acid muco,'. !~ substances were found specifically in prostatlc~ carcinoma. In our present case exhibiting aili~ signet ring cell appearance on conventional he, ~ matoxylin and eosin stain, there we: cosubstances in the intracellular an ring tumor cells with an alcian blu also showed positively for proste antigen supporting signet ring cells gland primary tumor. 1981 Tsuji Saitam; (DR. References 1. Royd S: A case of colloid scirrhus of the Pathol Soc Lond 33:200 (1882). 2. Foster EA, and Levine AJ: Mucin production in metastatic carcinomas, Cancer 16:506 (1963). 3. Pileher F: The significance of mucus in carcinoma of the:i prostate gland, Am J Clin Pathol 8" 366 (1938). 4. Elbadawi A, Craig W, Linke CA, and Cooper RA: Prostaticjli mucinous carcinoma, Urology 13:658 (1979). ai 5. Epstein JI, and Lieberman PH: Mucinous adenocareinom of the prostate gland, Am J surg Pathol 9:299 (1985). 6. Giltman LI: Signet ring adenocarcinoma of the prostate,j~ Urol 126; 134 (1981). 7. Kurus JJM, and Helsdingen PJRO: Signet-ring cell cariii~ cinoma of the bladder and the prostate. Report of 4 cases, Uro~i Int 40:116 (1985). 8. Uyama T, Hashimoto Y, and Moriwaki S: Mucus-forming.~ adenocarcinoma of the prostate--report of a case and review 01~7 the literature, Nishinihon J Urol 39:980 (1977). :~: 9. Chikazawa H, Uchihayashi T, and Ohtaki M: Mucus-form~i ing adenocarcinoma of the prostate: report of a case, Jpn J Clil~ Urol 28:743 (1974). . ~ 10. Franks LM, O'Shea JD, and Thomson AER: Mucin m the i prostate: a histoehemical study in normal glands, latent, clinical~ and colloid cancers, Cancer17:983 (1964). nd,! 11. Hukill PB, and Vidone RA: Histochemistry of mucus a other polysaccharides in tumors. II. Carcinoma of the prostate~

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Prostate mucinous adenocarcinoma with signet ring cell.

Carcinoma exhibiting signet ring cell appearance in the prostatic gland is rare. An example of this rare tumor is presented herein...
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