Embryonal rhabdomyosarcoma of the prostate in a young male: A rare case report

Embryonal rhabdomyosarcoma of prostate combined with prostatic abscess in an adult patient: a case report and literature review

Background

Embryonal rhabdomyosarcoma (ERMS) of the prostate is a rare and aggressive malignant tumor in adults with a poor prognosis in general. The main presenting symptoms are dysuria and acute urinary retention. Prostate ERMS is easily misdiagnosed, which leads to delays in treatment.

Case Description

We report the case of a previously healthy 31-year-old man who presented with dysuria for 3 months. Digital rectal examination (DRE), ultrasound, and computed tomography (CT) were suggestive of the possibility of a 2.0 cm × 3.0 cm abscess in the left lobe of the prostate. Prostate-specific antigen (PSA) was at a normal level, and C-reactive protein (CRP) concentration was elevated. The patient underwent surgical drainage by transurethral incision of the prostatic abscess. There was a significant improvement in the maximal urinary flow rate on postoperative day 5. However, the patient presented with acute urinary retention again on the 20th postoperative day. DRE and pelvic magnetic resonance imaging (MRI) showed a recurrence of an enlarged mass in the left lobe of the prostate. PSA level was again normal. Cystoscopy revealed a large neoplasm arising from the prostate obstructing the bladder outlet, and a diagnostic transurethral resection of this prostate tumor was performed. Histopathology revealed the mass to be an embryonic rhabdomyosarcoma. Subsequently, the patient was transferred to the Oncology Department and received chemoradiotherapy. After chemoradiotherapy, the size of the prostate became normal. Unfortunately, the patient deteriorated rapidly and eventually succumbed to multiple organ failure 1 year after the initial presentation.

Conclusions

Due to its non-specific presenting symptoms, prostate ERMS can be easily misdiagnosed, which can lead to treatment delay. Multimodality approaches, including neoadjuvant/adjuvant chemotherapy, radiotherapy, and radical resection, can improve the survival rate and reduce ERMS patient mortality.

Spindle cell embryonal rhabdomyosarcoma of the prostate in an adult patient: a case report and review of the literature

Rhabdomyosarcoma of the prostate is a rare mesenchymal tumor that originates from undifferentiated mesenchymal cells. Spindle cell rhabdomyosarcoma is a variant of embryonal rhabdomyosarcoma. The vast majority of these two pathological types occur in children, with only a few adult cases reported to date, and both are associated with poor clinical outcomes. We herein report a case involving a man in his early 40s with spindle cell embryonal rhabdomyosarcoma of the prostate. His chief complaint was difficult urination. The diagnosis was confirmed by puncture biopsy of the prostate, and pelvic lymph node metastasis was already present at the time of diagnosis. The patient underwent three courses of chemotherapy. However, his response to the treatment was very poor, and he died of the disease 4 months after diagnosis.

18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and 68Ga-prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging in the Evaluation of Rare Entity Adult Embryonal Rhabdomyosarcoma of Prostate

A 21-year-old male with embryonal rhabdomyosarcoma of the prostate was referred for 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and 68Ga-prostate-specific membrane antigen (PSMA) PET/CT for initial disease staging. The PET scans revealed hypermetabolic and PSMA expressing lobulated mass involving both lobes of the prostate and weakly metabolic and PSMA expressing few bilateral pararectal and external iliac nodes, multiple bilateral lung nodules scattered over the lung parenchyma and multiple bone marrow lesions in both axial and appendicular skeleton. Magnetic resonance imaging prostate showed gross prostatomegaly with large lobulated T2 hyperintense heterogeneously enhancing mass lesion showing restricted diffusion, involving both lobes of the prostate with extraprostatic spread along anterior, posterior, and left lateral margins with evidence of lymph nodal and osseous metastases. The demonstration of increased uptake of 18F-FDG and 68Ga-PSMA in the primary as well as bilateral pararectal and external iliac nodes, multiple bilateral lung nodules, and multiple bone marrow lesions in both axial and appendicular skeleton indicates a potential role of 18F-FDG PET/CT and 68Ga-PSMA PET/CT in disease staging in this rare aggressive tumor of the prostate.