Primary Prostatic Carcinoma With De Novo Diffuse Neuroendocrine Differentiation

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• The 2016 World Health Organization classification outlines several categories of prostate cancer with neuroendocrine (NE) differentiation.
• These include NE cells in usual prostate cancer, Paneth cell-like NE differentiation, carcinoid tumors, small cell NE carcinoma, and large cell NE carcinoma.

Observation:

• A rare case of primary prostatic carcinoma exhibiting de novo diffuse NE differentiation was identified in a 79-year-old male patient.
• The presentation included bilateral hydronephrosis and did not align with existing classification categories.
• Clinical, radiological, morphological, and immunohistochemical data were collected, alongside the patient's response to androgen deprivation therapy (ADT).

Findings:

• The presented case represents a novel form of prostatic neuroendocrine differentiation.
• Analysis revealed characteristics that distinguished it from established classifications.
• The patient's response to ADT provided insights into the potential management of such rare tumors.

Implications:

• This case challenges current understanding and classification of prostate cancer with NE differentiation.
• A proposed pathogenesis suggests transdifferentiation from conventional adenocarcinoma, induced by genomic alterations and ADT, leading to lineage plasticity.
• Further research into the mechanisms and clinical behavior of de novo NE differentiation in prostate cancer is warranted.