Neuroendocrine Carcinoma of the Seminal Vesicles
Neuroendocrine Carcinoma of the Seminal Vesicles
Introduction: Primary tumors of seminal vesicles are rare and only a few cases have been reported. Diagnosis is difficult due to the absence of early clinical signs. Prognosis is generally poor.
Case presentation: We present the case of a 70-year-old Caucasian man with a seminal vesicle mass and concomitant lymph node metastasis detected by computed tomography and body positron emission tomography/low-dose computed tomography scan carried out for evaluation of Lambert Eaton syndrome. Transrectal ultrasound-guided biopsy showed a poorly differented neuroendocrine carcinoma with an immunhistochemical profile similar to small cell lung cancer. Following chemotherapy the disease was stable and active surveillance was initiated.
Conclusions: Lambert Eaton syndrome may be the initial symptom of a seminal vesicle mass. Diagnosis needs to be obtained by transrectal biopsy and chemotherapy may delay progression of the tumor.
Primary tumors of seminal vesicles are extremely rare. A total of 51 documented cases of seminal vesicle carcinoma in men between the ages of 19 and 90 years old have been reported in the literature. The first case was presented by Lyons in 1925. Epithelial and mesenchymal tumors have been described most often, while fibromas, myomas and sarcomas are found even less often. Of all seminal vesicle tumors adenocarcinoma is the most prevalent. Primary seminal vesicle tumors have to be clearly distinguished from a neoplasm infiltrating from outside, e.g. prostate, rectal or bladder cancer. Tumors of seminal vesicle origin must be negative for prostate specific antigen (PSA), prostatic acid phosphatase (PAP) and preferably carcinoembryonic antigen to be distinguished from prostatic and colorectal carcinomas.
Seminal vesicle neoplasms are often difficult to diagnose, generally presenting as a retrovesical mass that can be detected by digital rectal examination and transrectal ultrasound. However, in roughly 30% of patients no abnormalities on digital rectal examination are detected due to concomitant benign prostatic hyperplasia obscuring the seminal vesicle tumor, or to location of the tumor in the seminal vesicles are found. In addition, computed tomography (CT) and magnetic resonance imaging (MRI) improve the assessment of seminal vesicle pathology.
Prognosis of patients with a seminal vesicle tumor is generally poor. Early diagnosis may result in long-term palliation or even cure. To date, no histopathological prognostic factor could be identified and the estimate of prognosis is challenging. Smith et al. state that seminal vesicle carcinoma can run a rapidly fatal course or possess potential for cure. Surgical procedures range from local excision of a seminal vesicle to pelvic exenteration. As an adjuvant treatment, radiotherapy, chemotherapy and hormonal manipulation are debated.
Abstract and Introduction
Abstract
Introduction: Primary tumors of seminal vesicles are rare and only a few cases have been reported. Diagnosis is difficult due to the absence of early clinical signs. Prognosis is generally poor.
Case presentation: We present the case of a 70-year-old Caucasian man with a seminal vesicle mass and concomitant lymph node metastasis detected by computed tomography and body positron emission tomography/low-dose computed tomography scan carried out for evaluation of Lambert Eaton syndrome. Transrectal ultrasound-guided biopsy showed a poorly differented neuroendocrine carcinoma with an immunhistochemical profile similar to small cell lung cancer. Following chemotherapy the disease was stable and active surveillance was initiated.
Conclusions: Lambert Eaton syndrome may be the initial symptom of a seminal vesicle mass. Diagnosis needs to be obtained by transrectal biopsy and chemotherapy may delay progression of the tumor.
Introduction
Primary tumors of seminal vesicles are extremely rare. A total of 51 documented cases of seminal vesicle carcinoma in men between the ages of 19 and 90 years old have been reported in the literature. The first case was presented by Lyons in 1925. Epithelial and mesenchymal tumors have been described most often, while fibromas, myomas and sarcomas are found even less often. Of all seminal vesicle tumors adenocarcinoma is the most prevalent. Primary seminal vesicle tumors have to be clearly distinguished from a neoplasm infiltrating from outside, e.g. prostate, rectal or bladder cancer. Tumors of seminal vesicle origin must be negative for prostate specific antigen (PSA), prostatic acid phosphatase (PAP) and preferably carcinoembryonic antigen to be distinguished from prostatic and colorectal carcinomas.
Seminal vesicle neoplasms are often difficult to diagnose, generally presenting as a retrovesical mass that can be detected by digital rectal examination and transrectal ultrasound. However, in roughly 30% of patients no abnormalities on digital rectal examination are detected due to concomitant benign prostatic hyperplasia obscuring the seminal vesicle tumor, or to location of the tumor in the seminal vesicles are found. In addition, computed tomography (CT) and magnetic resonance imaging (MRI) improve the assessment of seminal vesicle pathology.
Prognosis of patients with a seminal vesicle tumor is generally poor. Early diagnosis may result in long-term palliation or even cure. To date, no histopathological prognostic factor could be identified and the estimate of prognosis is challenging. Smith et al. state that seminal vesicle carcinoma can run a rapidly fatal course or possess potential for cure. Surgical procedures range from local excision of a seminal vesicle to pelvic exenteration. As an adjuvant treatment, radiotherapy, chemotherapy and hormonal manipulation are debated.
