An Autopsy Case of Prostatic Cancer Accompanied by Granular Lymphocyte Proliferation Disease(GLPD) and Hemophagocytic Histiocytosis.

A rare autopsy case of granular lymphocyte proliferation disease (GLPD) accompanied by hemophagocytic histiocytosis and systemic lymph node swelling due to metastasis from prostatic carcinoma, was reported.An 87-yr-old man was admitted because of general fatisue, loss of consciousness and paresthesia of the right foot. General clinical examination revealed systemic lymphadenopathy without splenomegaly and mild hepatic dysfunction. Hematological examination showed leucocytosis with a marked increase of large granular lymphocytes (LGL) and a decrease of T cells in the peripheral blood. Upon immunological examination, CD3- CD57+ CD16+ LGL were numerically dominant which was suggestive NK-type GLPD.After a two months' asymptomatic course, sudden severe repiratory distress and mild jaundice appeared, and the patient died 3 days later.Autopsy revealed enlargement of the systemic lymph nodes due to cancer metastasis, central liver cell necrosis, and bleeding and marked congestive edema of the lungs with pleural effusion. Microscopic exmination disclosed well differentiated adenocarcinoma of the prostate with lymph node involvement. However, there were no metastatic lesions in the other organs and tissues examined. Prominent distribution of hemophagocytic histiocytosis was recognized in the lymph nodes, spleen and liver.Immunohistochemically, T cells were decreased in number in the lymphoid tissues, and also CD57+ LGL were decreased in the lymph nodes involved with cancer cells. The CD57+ LGL in lymph nodes failed to express HLA-DR (LN 3).In this case, it was considered that latent prostatic carcinoma might be have undergone rapid growth with widespread lymph node involvement within a short period under condition of disturbed immunoregulation due to GLPD, decrease of T cells and hemophagocytic histiocytosis. And also, it was possible that metastatic cancer involvement caused proliferation of LGL.