Adenoid cystic carcinoma of Cowper's gland: case report

Cystic Pelvic Masses in Men: A Presentation of Uncommon Cases and a Literature Review

Unclear cystic masses in the pelvis in male patients are a rare situation and could be of benign or malignant origin. The underlying diseases demand for specific diagnostic and therapeutic approaches. We present a case series of 3 male patients with different clinical symptoms (perineal pain, urinary retention and a large scrotal cyst) related to cystic lesions in the pelvic region. On all patients initial histopathological workup was unclear. All patients underwent surgery with complete resection of the tumor which revealed a broad spectrum of histopathological findings: unusual form of cystic adenocarcinoma of the prostate, malignant transformation of a dysontogenetic cyst, and finally a very rare diagnosis of a malignant tumor of the Cowper gland. This case series and literature review provide clues for a possible diagnostic and therapeutic approach in the case of unclear pelvic cystic masses and could support urologists during the therapy selection in the future.

Imaging of the Bulbourethral (Cowper) Gland: Abnormalities and Differential Diagnosis

Normal Cowper glands and ducts are imperceptible at imaging. However, abnormalities of the Cowper glands and ducts are increasingly seen owing to increasing use of cross-sectional imaging. In this article, the authors present a comprehensive review of the normal anatomy of the Cowper glands and ducts and the clinical and imaging findings of conditions that affect them in an effort to help lead to appropriate diagnosis and management. A Cowper duct syringocele is a congenital or acquired dilatation of the Cowper duct in the bulb of the corpus spongiosum. Retrograde urethrography is the standard test to diagnose a communicating (open) Cowper duct syringocele, and MRI is used for further morphologic assessment. Cowperitis refers to inflammation of the gland and/or duct, and recurrent cowperitis is usually associated with an underlying syringocele, a urethral fistulous connection to the Cowper gland, or a perianal fistula. MRI allows detection of the underlying structural abnormality and the superimposed inflammation. Cowper stones are typically radiopaque and are found in both the Cowper gland and duct. A Cowper gland HHhemorrhagic cyst may be incidentally detected at MRI of the prostate, and follow-up MRI may be required to ensure evolution of hemorrhage and exclude an underlying neoplasm. Cowper gland carcinoma is rare and includes adenocarcinoma and adenoid cystic carcinoma subtypes. Transperineal US may be used for initial evaluation and CT and/or MRI are necessary for further characterization and staging. Cowper gland hyperplasia is a rare entity with few previous reports that may be incidentally detected at imaging and may mimic malignancy. ^©RSNA, 2022.

Cowper's gland hyperplasia: A potential pitfall at MRI of the prostate

MRI features are presented in a multicenter retrospective series of five patients with a unilateral masslike lesion seen in the genitourinary diaphragm at MRI performed for known or suspected prostate cancer. In all cases, the lesion appeared as an encapsulated 1.3 to 3.0 cm mass of heterogeneous low or intermediate T2 signal intensity in the genitourinary diaphragm, and targeted biopsy demonstrated benign Cowper's gland tissue. This entity is a potential imaging pitfall that could result in a diagnosis of an exophytic nodule of benign prostatic hyperplasia or local spread of prostate cancer. We present these cases to facilitate correct identification of Cowper's gland hyperplasia as an occasional finding at MRI of the prostate.

High grade transformation of adenoid cystic carcinoma in the palate: Case report with review of literature

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High Grade Transformation of Adenoid Cystic Carcinoma in the palate is very rare tumor.

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It represents a challenge in both diagnosis and management, with limited experience available.

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The microscopic diagnosis and management is challenging, considering the sarcacity of the tumor.

Introduction

Adenoid cystic carcinoma (ACC) is a rare tumor developed in minor salivary glands, the palate being the most common site.

Case presentation

Here, we report a case of a 58-year-old man with a 3-year-growing swelling in the right palate diagnosed with high grade transformation adenoid cystic carcinoma. The exam revealed a 4 cm large mass. A tumor resection with a radical neck dissection was performed.

Discussion

High grade transformation in adenoid cystic carcinoma is recently described by Cheuk et al. in 1999. This transformation has more aggressive behavior than conventional solid ACC and has usually been associated with recurrences, early distant metastasis, and greater mortality.

Conclusion

The aim here is to highlight clinical, histopathological, therapeutic and prognostic aspects of high-grade transformation in ACC with literature review.

Mucoepidermoid carcinoma of the penis: Case report and literature review

We describe the fifth case of mucoepidermoid carcinoma. The patient had penile ulcer with bilateral inguinal and pelvic lymphadenopathy and underwent total penectomy. After antibiotic therapy, the patient began outpatient chemotherapy, but the treatment was discontinued due to his intolerance. The patient died due to infectious complications of the inguinal lymphatic fistula 7 months after the histological diagnosis. Notably, the periurethral area was involved in the anatomopathological evaluation of the excised penis. The penile mucoepidermoid carcinoma was aggressive and the perimeatal region was involved. This case helps demystify the origins and prognosis of this rare case. More reports documenting patient characteristics and their evolution with penile mucoepidermoid carcinoma are needed.

Adenoid cystic carcinoma: An unusual presentation

The adenoid cystic carcinoma is a relatively rare epithelial tumor of the major and minor salivary glands, accounting for about 1% of all malignant tumor of the oral and maxillofacial regions. Peak incidence occurs between the 5^th and 6^th decades of life. The clinical and pathological findings typical of this tumor include slow growth, peri-neural invasion, multiple local recurrences and distant metastasis. Herein, we report a case of adenoid cystic carcinoma of oropharynx with unusual clinical presentation. The diagnosis of this case and importance of cytology in diagnosing such cases is discussed.

Metastatic Cancer of Cowper's Gland: A Rare Cancer Managed Successfully by Molecular Profiling

Cancer of Cowper's gland is a very rare cancer. This case represents the 9th case in the medical literature. As such, there are no phase II or phase III trials to guide treatment. In this article, we report the successful treatment of a patient over a 7-year period guided solely by molecular profiling. Through multiple cycles to treatment, the cancer was controlled using drugs targeting c-kit, as the cancer steadily increased the expression of c-kit. This report also documents the use of a novel drug combination based on sunitinib that was well tolerated and may warrant testing in other c-kit-dependent cancers.

Adenoid cystic carcinoma - Clinical presentation and cytological diagnosis

Adenoid cystic carcinoma is a tumor arising from the minor salivary glands, the palate being the commonest site. It accounts for about 1% of all head and neck malignancies. We report a case with the typical presentation of a palatal growth with extensive intra-cranial invasion. The diagnosis of this case and a brief review of literature is discussed. Final diagnosis of this case was made from cytological reports. The dry smears stained with MGG were found to be definitely superior to the alcohol fixed slides stained with papanicolaou. The aim here is to highlight the importance of cytology in the diagnosis of such tumors.

Adenoid cystic carcinoma: a rare clinical entity and literature review

The adenoid cystic carcinoma is a relatively rare epithelial tumor of the major and minor salivary glands, accounting for about 1% of all malignant tumor of the oral and maxillofacial region. Although it presents a widespread age distribution, peak incidence occurs predominantly among women, between the 5th and 6th decades of life. The clinical and pathological findings typical of this tumor include slow growth, perineural invasion, potential local recurrence and distant metastasis. Histopathologically it is composed of basaloid cells with primarily myoepithelial/basal cell differentiation. It presents three patterns, cribriform, tubular and solid; the solid type is related to a poor prognosis contrary to the cribriform type, which has a better prognosis. Surgical excision with wide margins is the treatment of choice, if it metastasizes to lymph nodules, post surgical radiotherapy is recommended. We presented herein the case of a 45 year old female patient who presented a palatal lesion, which was treated with surgery and radiotherapy as an additional treatment. We also described a brief literature review of adenoid cystic carcinoma.

Mucoepidermoid carcinoma arising in the glans penis

Mixed carcinoma (squamous and glandular) of the penis is a rare neoplasm with an unknown origin and a poorly defined prognosis. The mucoepidermoid carcinoma described herein has not been previously reported to our knowledge. The present carcinoma arose from and extensively ulcerated the squamous epithelium of the glans penis, including that surrounding the urethral meatus. The neoplasm was composed of well-differentiated nonkeratinizing squamous cell carcinoma associated with large areas of carcinoma formed by cell nests that contained poorly differentiated squamous elements and large eosinophilic to pale granular cells. Mucin stains revealed approximately one quarter of the pale cells contained mucous substances. These findings are virtually identical to the mucoepidermoid type of carcinoma seen in the cervix. The 3 previously reported cases of adenosquamous carcinoma of the penis demonstrated a relatively indolent course, with only one being associated with a single inguinal lymph node metastasis. That patient was alive and well 9 years following diagnosis. Our example of mucoepidermoid carcinoma appears to demonstrate a more aggressive course than those reported previously.

Metastatic Adenoid Cystic Carcinoma of Salivary Glands: Case Reports and Review of the Literature

BACKGROUND: Adenoid cystic carcinoma is an uncommon tumor of the salivary gland. Little has been published on the chemotherapy of this neoplasm. METHODS: The literature on this disease is reviewed, and data from seven unpublished cases are presented. RESULTS: Four patients received cyclophosphamide. One responded, and another had pain relief. The literature review did not identify any single drug or combination that might be regarded as the treatment of choice. CONCLUSIONS: Systematic, multi-institutional studies are required to determine appropriate systemic treatment for metastatic adenoid cystic carcinoma of salivary gland origin.

Surface adenosquamous carcinoma of the penis. A report of three cases

Three patients, aged 37, 72, and 74 years, with adenosquamous carcinoma of the penis are described. The duration of disease was 6, 9, and 144 months, respectively. Grossly a firm, white-gray granular exophytic mass was noted (7.6 cm average diameter). Microscopically, a mixed carcinoma showing squamous and glandular elements was present; the squamous component predominated. In two cases the adenocarcinoma was located in the perimeatal area of the glans. The periurethral glands were not involved. The glandular foci were discrete and had minimal admixture with the squamous carcinoma. Mucin material was present in the lumina, apical border, and cytoplasm. Immunohistochemically, cells showed positivity for carcinoembryonic antigen in glandular areas. The squamous cell carcinomas were of the "warty" variant in two cases and of the usual squamous cell type in the other case. In one patient, metastatic adenosquamous carcinoma was noted in one inguinal node and showed mucin secretion. This patient is alive and well 102 months after diagnosis. Another patient is alive with no evidence of disease 12 months after surgery, and the third was lost to follow-up. Adenosquamous carcinomas of the penis are unusual neoplasms probably originating in penile surface epithelium and in embryologically misplaced mucus glands of the perimeatal region of glans mucosa.

Adenoid cystic carcinoma of Cowper's gland

We report an additional case of primary adenoid cystic carcinoma of Cowper's gland in an otherwise healthy asymptomatic 66-year-old man. Based on a review of similar lesions presenting in the head and neck, our treatment plan entailed pelvic exenteration followed by radiation therapy. Whether adenoid cystic carcinoma of Cowper's gland behaves as aggressively as it does in the head and neck remains unclear. However, in view of the extensive local invasion in our patient and a previously successful outcome, a combined surgical and radiation approach appears to be the most appropriate therapy.

Adenoid cystic carcinoma of the palate in a 9-year-old boy

Malignant tumors of salivary glands in children are extremely rare. A case of an adenoid cystic carcinoma affecting the palate in a 9-year-old child is described. This tumor has not previously been reported as affecting the minor salivary glands among patients in this age group.

Adenoid cystic carcinoma of the salivary glands: an immunohistochemical analysis

Adenoid cystic carcinoma is a specific variant of adenocarcinoma with a characteristic cribriform appearance. The tumor may arise from salivary glands and various other sites, but the origin and cellular composition of this unique neoplasm have been controversial. A potential use of immunohistochemistry is to provide additional information on the origin of various cellular components of tumors by comparing them with corresponding normal tissues. Immunohistochemical distributions of carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), keratin, low molecular weight keratin (54 kd), S100 protein, muscle-specific actin, laminin, and type IV collagen were evaluated in 20 adenoid cystic carcinomas arising in major and minor salivary glands. Anti-CEA, anti-EMA, anti-keratin, and anti-S100 antibodies strongly stained cells lining true lumina. Muscle-specific actin, a marker for myoepithelial cells, was found in lining cells of pseudocysts, in tumor cells proper, and in nonluminal cells with a tubular growth pattern. A monoclonal antibody against 54 kd keratin stained almost all cells in the neoplasms. In pseudocysts, replicated basal lamina reacted with antisera to laminin and to type IV collagen. The present study demonstrates that there are at least two populations of tumor cells in adenoid cystic carcinoma: luminal cells that express CEA and EMA, thus indicating their ductal character, and nonluminal cells that express muscle-specific actin characteristic of myoepithelium.

Adenoid cystic carcinoma: biologic behavior in 38 patients

This study presents the clinical and pathologic data on 38 patients with adenoid cystic carcinoma. Most of the tumors arose from the major salivary glands or the mucus glands of the upper respiratory tract and oral cavity. The typical biological behavior of these tumors was slow but aggressive local growth despite all therapy, followed by eventual death from local disease and/or metastases. Twenty-eight of the patients have died, 22 from adenoic cystic carcinoma, 3 from postoperative complications, and 3 from intercurrent disease. Of the 10 living patients, 4 have active disease, 2 have no evidence of disease 14 years after diagnosis, and 4 have no evidence of disease but follow-up is less than 5 years. We compared various microscopic features of the tumors, including histologic grading, with prognosis but did not demonstrate a correlation in this small series.

Adenoid cystic carcinoma of the prostate: report of a case

Adenoid cystic carcinoma of the prostate is a rare but distinctive variant of prostatic adenocarcinoma. A case report is presented and the pathology, differential diagnosis and treatment modalities are discussed.

Lymph node involvement by direct extension in adenoid cystic carcinoma. Absence of classic embolic lymph node metastasis

Thirty-four cases of adenoid cyctic carcinoma seen at the University of Virginia Hospital from 1946 to 1974 were reviewed, with special emphasis on lymph node involvement by tumor. Lymph node involvement was found in three cases of primary tumors of the submaxillary gland, and all of the affected lymph nodes were in the immediate vicinity of the primary tumor. Two lymph nodes were involved in two of the cases, and one node was involved in the third case. In all of these lymph nodes, adenoid cystic carcinoma was present in the soft tissue surrounding the node, and the tumor extended into the node. No metastatic tumors were observed in 46 lymph nodes removed incidentally at the time of local excision of the primary tumors in 10 additional cases or in 212 lymph nodes examined after unilateral radical neck dissections in six other cases. Five autopsies in this series showed no lymph node metastases. In this series of cases adenoid cystic carcinoma only invades lymph nodes in the immediate vicinity of the primary tumor. When lymph node involvement does occur, it does not result from embolic lymph node metastasis; rather, a direct invasion of the lymph node from tumor in the perinodal soft tissue occurs. Obviously, this small study does not completely exclude the possibility of embolic metastasis; however, if it does occur, it must be extremely rare.