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prostate squamous cell carcinoma

ICD-0:8070/3

Saturday 18 February 2012

Definition: Prostate carcinoma with squamous cell differentiation.

Epidemiology

The incidence of squamous cell carcinoma of the prostate is less than 0.6% of all prostate cancers. There are 70 cases reported in literature.

Even more rare is adenosquamous carcinoma of the prostate, with about 10 cases reported so far.

For primary prostatic squamous cell carcinoma an association with
Schistosomiasis infection has been described.

Localization

Squamous cell carcinomas may originate either in the periurethral glands or in the prostatic glandular acini, probably from the lining basal cells, which show a divergent differentiation pathway.

Clinical features

Most, if not all pure squamous cell carcinomas become clinically manifest by local symptoms such as urinary outflow obstruction, occasionally in association with bone pain and haematuria.

Most patients have at the time of diagnosis metastatic disease, and bone metastases are osteolytic. PSA levels are not typically elevated. The age range of patients is between 52 and 79 years.

Hormone treatment and chemotherapy are not effective, except for a single case with non-progressive disease after local irradiation and systemic chemotherapy.

In cases of organ-confined disease, radical prostatectomy or cystoprostatectomy, including total urethrectomy is recommended.

Tumour spread

Both squamous cell carcinomas and adenosquamous carcinomas tend to
metastasize rapidly with a predilection for the skeletal bones.

Histopathology

By definition pure squamous cell carcinoma does not contain glandular features and it is identical to squamous cell carcinoma of other origin.

With rare exception, it does not express PSA or PAP.

Primary prostatic squamous cell carcinoma must be distinguished on clinical grounds from secondary involvement of the gland by bladder or urethral squamous carcinoma.

Histologically, squamous cell carcinoma must be distinguished from squamous metaplasia as may occur in infarction or after hormonal therapy.

Adenosquamous carcinoma is defined by the presence of both glandular (acinar) and squamous cell carcinoma components.

Some authors considered the possibility that adenosquamous carcinomas consist of collision tumours with a de novo origin of adenocarcinoma and squamous cell carcinoma.

The glandular tumour component generally expresses PSA and PAP, whereas the squamous component displays high molecular weight cytokeratins.