Spindle-cell carcinoma of the prostate

Abstract

Sarcoma of the prostate and sarcomatoid carcinoma of the prostate are rare
conditions, both characterized by a poor prognosis. Sarcomatoid carcinoma of
the prostate typically arises from the evolution of an underlying adenocarcinoma,
occasionally featuring heterologous elements, bulky disease being possible
but rare. In contrast, sarcoma of the prostate derives from non-epithelial
mesenchymal components of the prostatic stroma, shows rapid growth, and
frequently presents as massive pelvic tumors obstructing the urinary tract
at the time of diagnosis. We report the case of a 55-year-old patient with a
two-month history of symptoms of urinary obstruction. The patient presented
with an extremely enlarged heterogeneous prostate, although his prostatespecific
antigen level was low. The lack of a history of prostatic neoplasia led
us to suspect sarcoma, and a transrectal prostate biopsy was carried out. An
immunohistochemical study of the biopsy specimen did not confirm the clinical
suspicion. However, in view of the clinical features, we believe that sarcoma of
the prostate was the most likely diagnosis. The patient received neoadjuvant
chemotherapy followed by radiation therapy. At this writing, surgical resection
had yet to be scheduled.