International Journal of Urology

(2003)

10,

114–116

Case Report

Blackwell Science, LtdOxford, UKIJU

International Journal of Urology0919-81722003 Blackwell Science Asia Pty Ltd

102February 2003580

Squamous cell carcinoma of the prostateH Mohan

et al.

10.1046/j.0919-8172.2002.00580.xCase ReportBEES SGML

Correspondence: Harsh Mohan

MD

MNAMS

, Department ofPathology and Surgery, Government Medical College andHospital, Sarai Building, Sector 32-A, Chandigarh, India.Email: harshmohan@glide.net.in

Received 9 October 2001; accepted 12 August 2002.

Squamous cell carcinoma of the prostate

HARSH MOHAN,

1

AMANJIT BAL,

1

RAJ PAL SINGH PUNIA

1

ANDAMARPREET SINGH BAWA

2

Departments of

1

Pathology and

2

Surgery, Government Medical College, Chandigarh, India

Abstract

Squamous cell carcinoma of the prostate is rare, accounting for 0.5–1% of all prostatic cancers. It ishighly aggressive and responds poorly to any mode of therapy. We present a case of squamous cellcarcinoma of the prostate that developed in a patient with prostatic adenocarcinoma following radi-ation therapy.

Key words

prostate, squamous cell carcinoma.

Introduction

Adenocarcinoma is the most common malignancy of theprostate. Other malignancies such as primary transi-tional cell carcinoma, squamous cell carcinoma andmixed carcinomas have been reported rarely. Squamouscell carcinoma of the prostate is extremely rare, com-prising only 0.5–1% of all prostatic carcinomas.

1

About65 cases of squamous cell carcinoma of the prostatehave been reported in the literature (Table 1). We reporta case of squamous cell carcinoma of the prostate devel-oping in a patient with adenocarcinoma of the prostatefollowing radiation therapy.

Case report

A 69-year-old male presented to our hospital in January2001 with the complaint of acute retention of urine.Rectal examination showed an enlarged and hard pros-tate gland. Serum prostate specific antigen (PSA) levelwas normal (0.4 ng, ELISA technique). Urethroscopy,cystoscopy and urine cytology were negative for malig-nancy. Transurethral channelling was conducted torelieve the symptoms and prostatic chips were sent forhistopathologic examination.

The past history of the patient included similar com-plaints in February 1997, for which he was investigated

thoroughly at another hospital. Records showed raisedlevels of PSA (68 ng). He had undergone transurethralresection (TUR) of prostate and the histology reportwas adenocarcinoma of the prostate, Gleason grade 4 A,while the stage was not known. Following that, heunderwent bilateral orchiectomy in March 1998 and wasgiven radiation therapy. Details of dosage of radiationand previous biopsy slides were not available for review.

During the present admission, the patient left thehospital against our medical advice and discontinuedfollow-up even before the histopathological report wassubmitted.

Histopathological findings

Grossly, TUR specimen was in the form of multiple graywhite prostatic chips measuring in total 2.2 g. Micro-scopic examination revealed squamous metaplasia ofthe prostatic glands and ducts (Fig. 1). In addition, therewere areas of invasive squamous cell carcinoma charac-terized by nests and sheets of malignant squamous cellsinfiltrating the fibromuscular stroma (Fig. 2). Focalareas showed evidence of keratin pearl formation. Therewas no evidence of adenocarcinoma in the multiple sec-tions studied.

Discussion

Squamous cell carcinoma of the prostate is extremelyrare, accounting for 0.5–1% of all prostatic cancers. Itusually presents in the seventh decade or later agegroup. Presenting symptoms are usually of urinary

Squamous cell carcinoma of the prostate 115

obstruction or bone pains due to metastases. It is diffi-cult to differentiate clinically squamous cell carcinomafrom prostatic adenocarcinoma. Clinical points favoringthe diagnosis of squamous cell carcinoma include lowserum acid phosphatase and PSA levels, and osteolyticbony metastasis.

2

Confirmation of the diagnosis of squa-mous cell carcinoma of the prostate is made on histo-logic examination only. Mott

1

suggested the followingcriteria for diagnosis: (i) clearly malignant neoplasmjudged by invasion, growth pattern and cellular anapla-sia; (ii) squamous features of keratinization, keratinpearls and intercellular bridges; (iii) lack of glandulardifferentiation; and (iv) absence of primary squamouscell carcinoma elsewhere, particularly in the bladder.

Histogenesis of squamous cell carcinoma of the pros-tate is not clear. It is speculated that the squamous com-ponent is derived from squamous metaplasia of aciniand ductal elements following radiation or hormonaltherapy for prostatic adenocarcinoma.

3

It has also beenproposed that squamous cell carcinoma is derived frompluripotent stem cells capable of multidirectional differ-entiation.

4

Benign squamous metaplasia in the prostatefollowing radiation therapy is well documented butmalignant transformation is rare. Squamous cell carci-noma of the prostate is a highly aggressive tumor with alow survival rate because it responds poorly to any modeof therapy. It commonly metastasizes to the bone, liver

and lungs. The average survival period after diagnosis is14 months.

5

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Fig. 1

Photomicrograph showing squamous metaplasiaof the prostatic glands (H&E

¥

200).

Fig. 2

Photomicrograph showing nests of malignantsquamous cells infiltrating the fibromuscular prostaticstroma (H&E

¥

100).

Table 1

Reported cases of squamous cell carcinoma of theprostate

Serial no. Authors No. cases

1. Goto

et al

.

6

(Japanese) 122. Nabi

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7

23. Puyol

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8

14. Rahmanou

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9

15. Imamura

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16. Okada

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11

17 Miller

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12

18. Braslis

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13

19. Ullo

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14

110. Perez

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15

111. Little

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16

212. Uchibayashi

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17

113. Moskovitz

et al.

5

114. Sarma

et al.

2

115. Wernert

et al.

18

1116. Asuero

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19

117. Samsonov

20

1618. Al Adnani

21

219. Sharma

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22

120. Mott

1

221. Gray

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23

122. Kastendieck

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24

123. Sieracki

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