SESSION TYPE: Cancer Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Basal cell carcinoma is an extremely rare (<0.01%) form of malignant prostate cancer. We present a patient who was initially treated for neuroendocrine carcinoma of the prostate, later found to be basal cell carcinoma. Despite standard treatment for basal cell carcinoma, he had a recurrence of the tumor with metastatic disease and an aggressive clinical course.
CASE PRESENTATION: A 68-year-old male with hypertension and chronic obstructive pulmonary disease underwent a trans-urethral resection of the prostate for severe urinary symptoms due to benign prostatic hyperplasia not responsive to medical therapy. Routine biopsy was initially read as poorly differentiated neuroendocrine carcinoma of the prostate as they stained positive for neuron specific enolase but not synaptophysin or chromogranin. Initial imaging including PET scan, CT pelvis and skeletal survey showed no evidence of metastatic disease. He underwent neoadjuvant chemotherapy with four cycles of carboplatin and etoposide. Repeat biopsy unfortunately revealed persistence of malignancy but this time was read as basal cell carcinoma. Initial biopsies were reevaluated by two independent pathologists and were relabeled as poorly differentiated basal cell carcinoma cells. He underwent a prostatectomy, and intraoperatively he was noted to have extensive local infiltration to surrounding pelvic structures. He required a cystectomy but the family declined it. Based on these findings, he was staged as pT4N0MX, stage IV. He underwent radiosensitizing chemotherapy with low dose cisplatin for 8 weeks. Despite this, the patient continued to have a slow decline in overall health and started to develop respiratory symptoms. Repeat imaging within the year of initial diagnosis showed extensive metastatic disease to the bones and lungs. Chemotherapy with docetaxel was started with minimal response.
DISCUSSION: Basal cell proliferation of the prostate has a wide range of morphology ranging from basal hyperplasia to basal cell carcinoma; though specific criteria to differentiate their histology and clinical behavior do not exist. Most basal cell carcinoma are thought to be low grade carcinomas and have indolent behavior, however our case demonstrates that more aggressive forms do exist.
CONCLUSIONS: Knowledge of basal cell carcinoma of prostate cancer is sparse with only 57 cases published in literature to date. Pure basal cell carcinoma is rare, and immunohistological staining is important to differentiate it from other forms of prostate cancer. Due to the rarity of basal cell cancer, it can be misdiagnosed. Thus second opinion on histology of suspicious/rare subtypes of the prostate should be sought.
1) K Komura. et al. Basal cell carcinoma of the prostate: unusual subtype of prostatic carcinoma. Int J Clin Oncol 2010: 15:594-600.
2) B Helpap. et al. Importance of second opinions on histology of prostate biopsy specimens. Pathologe. 2012 Mar;33(2):103-12
DISCLOSURE: The following authors have nothing to disclose: Gayathri Sathiyamoorthy, Sonia Nayyar, Bhuvaneswari Ramkumar, Ajeet Gajra
No Product/Research Disclosure InformationUpstate University Hospital, Liverpool, NY