Analysis of prostatic spindle cell lesions: Three case reports and literature review

Spindle cell lesions of the prostate originate from the specialized stroma or prostate epithelium. At present, these lesions are relatively rare, but the histomorphological features they involve are extremely diverse, which can easily lead to misdiagnosis in the clinical diagnosis process. This study reports on 3 cases of different types of spindle cell lesions of the prostate, with the aim of providing valuable reference information for clinicians when dealing with such cases, to help them make more accurate and effective clinical decisions. A retrospective analysis of the clinical data of 3 patients diagnosed with different spindle cell lesions of the prostate at the Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, from January 2023 to October 2024. All 3 patients underwent transperineal prostate biopsy with 12 needles. Two patients were diagnosed with the assistance of fluorescence in situ hybridization (FISH). Based on pathological examination and immunohistochemical testing results, 1 patient was diagnosed with nodular hyperplasia of prostatic interstitial smooth muscle. The other 2 patients who underwent FISH testing were diagnosed with prostatic stromal sarcoma in one case and prostatic synovial sarcoma in the other. One patient elected to undergo transurethral holmium laser-induced prostatectomy. Another patient received targeted therapy with anlotinib. The third patient received liposome doxorubicin combined with ifosfamide chemotherapy. For the cases of nodular hyperplasia of prostatic interstitial smooth muscle, no signs of recurrence have been found so far. The patient with prostatic stromal sarcoma unfortunately passed away after 3 months of follow-up. However, during the subsequent observation period, the tumor volume of patients with synovial sarcoma of the prostate exhibited a reduction, and no further deterioration was noted. Spindle cell lesions of the prostate have diverse histological manifestations. A diagnosis can only be confirmed through the results of a biopsy and immunohistochemistry. Classification of some tumors should also be diagnosed with the assistance of FISH. Once diagnosed, timely intervention is required, including surgery, adjuvant radiotherapy, adjuvant chemotherapy, targeted therapy, etc. Malignant tumors, in particular, progress rapidly and have a poor prognosis, so a detailed treatment plan needs to be formulated.