Primary carcinoid tumor of the urethra

Secreting Benign Paraganglioma of the Prostatic Urethra

A case of benign paraganglioma of the prostatic urethra, incidentally discovered in a hyperplastic gland, is reported. Presurgical mild systemic hypertension, which suggested the paraganglioma secreting activity, became normal in the postoperative follow-up.

Carcinoid tumor of the verumontanum (colliculus seminalis) of the prostatic urethra with a coexisting prostatic adenocarcinoma: a case report

INTRODUCTION

Urethral carcinoid tumors are very rare tumors with only four cases described in the literature.

CASE PRESENTATION

We present the case of a 61-year-old man with a primary carcinoid tumor of the verumontanum (colliculis seminalis) portion of the prostatic urethra with a coexisting prostatic adenocarcinoma. In addition to whole mount hematoxylin and eosin staining, special immunoperoxidase staining specific for chromogranin A, neuron specific enolase, synaptophysin, pan-cytokeratin and PSA, and a special combined staining for racemase (alpha-methyl CoA) antigen and p63 antigen were performed. A review of the literature is included.A single focus of invasive prostatic adenocarcinoma was identified in the periphery of the mid-left, posterior quadrant of the prostate. Approximately 17 mm from this adenocarcinoma, within the verumontanum of the prostatic urethra, there was a 3 mm maximal dimension carcinoid tumor.

CONCLUSION

Based on different histological features and antigenic profiles, we concluded that the two tumors were distinct.

Carcinoid tumors of the urinary tract and prostate

CONTEXT

Carcinoid tumors are exceedingly rare in the genitourinary tract and may occur in the kidney, urinary bladder, urethra, or prostate.

OBJECTIVE

To review the clinical and pathologic features of carcinoid tumors occurring in the urinary tract and prostate.

DATA SOURCES

We searched the English language literature using MEDLINE and Ovid.

CONCLUSIONS

Carcinoid tumors of the urinary tract and prostate share similar morphologic features with their counterparts in other organs. The differential diagnosis includes metastatic carcinoid tumor, paraganglioma, and nested variants of urothelial and prostatic carcinomas. Correlation of the clinical presentation and histopathologic features (including the immunohistochemical profile) will ensure accurate diagnosis of these rare tumors.

Carcinoid tumor in the female urethral orifice: rare case report and a review of the literature

We experienced an extremely rare tumor in the female urethral orifice in a 57-year-old Japanese woman. To our knowledge, only two cases of primary urethral carcinoid tumor have been reported. The previous reports of urethral carcinoid tumor were recognized in the male middle urethra and penile urethra. The present case was resected, and diagnosed as a carcinoid tumor by histological, immunohistochemical and ultrastructural findings. The tumor cells were stained by chromogranin A, synaptophsin and neuron-specific enolase, and neurosecretory granules were confirmed with electron microscopy. The patient did not complain of any symptoms until 5 years after the resection of the tumor. Therefore, the case we describe here is the first known report of carcinoid tumor in the Japanese female urethra.

Primary carcinoid tumor of the urinary bladder

A polyp of about 1.0 cm diameter was incidentally found at the center of the posterior wall of the urinary bladder in a 73-year-old man on cystoscopic examination. A polyp was resected through a transurethral route without recurrence for 22 months. A polyp consisted of a tumor covered with mucosa of the bladder. Tumor cells have round or oval nuclei with fine chromatin and one or two nucleoli per nucleus, and finely granular eosinophilic cytoplasm, being arranged in a trabecular or tubular pattern. Furthermore, they showed positive staining for chromogranin-A and with Grimelius stain, indicating that the tumor is a carcinoid tumor. Since there was no evidence of carcinoid tumors in organs other than the urinary bladder, the present case is a primary carcinoid tumor (well differentiated endocrine tumor) of the urinary bladder which is extremely rare.

Primary neuroendocrine carcinoma of the urethra

We present a rare case of a primary neuroendocrine carcinoma of the urethra after radical cystectomy and orthotopic urinary reconstruction for transitional cell carcinoma of the urinary bladder.

Primary carcinoid tumour with ossification masquerading as calyx stone in a horseshoe kidney

A case of renal carcinoid tumour arising within a teratoma in a horseshoe kidney in a 23-year-old male is reported. The presenting symptom was abdominal pain, and bone tissue within the tumour was initially misinterpreted as a calyx stone, leading to unsuccessful attempts at extracorporeal shock-wave lithotripsia and percutaneous lithotripsia. This unusual tumour is over-represented in patients with horseshoe kidney and other congenital developmental renal defects.

Carcinoid disease: review of the literature

Carcinoid syndrome is the product of a rare but fascinating malignant neoplasm. Carcinoid syndrome was described more than 100 years ago, and recent advances in diagnostic localization, elucidation of the mechanisms of oncogenesis, treatment options, and, consequently, patient prognosis have been made. Current modalities of treatment, possible therapeutic implications of new avenues of research, and current literature on the chemotherapeutic combinations used are reviewed.

Primary carcinoid of the kidney

A rare case of primary renal carcinoid tumour is presented. The diagnosis was based on immunohistochemically diffuse cytoplasmic positivity for chromogranin A and neuron-specific enolase, in addition to histologic findings. Only 14 previous cases of this tumour have been documented in the literature.

Neuroendocrine differentiation in human prostatic carcinoma

Endocrine-paracrine (APUD, neuroendocrine) cells are located in the prostatic ductal and acinar epithelium. These cells are of the open and closed type and have dendritic processes. There is a wide range of secretory granule morphology presumably indicating a variety of different cell "types." Secretory immunoreactive peptides include serotonin, calcitonin (and related peptides), somatostatin, bombesin-like, thyroid-stimulating hormone-like (beta chain), and alpha-glycoprotein chain-like. These cells may function by endocrine, paracrine, neurocrine, and lumencrine mechanisms and play an important regulatory role both during growth and differentiation of the prostate as well as in the secretory process of the mature gland. Neuroendocrine differentiation in prostatic carcinoma is a frequent occurrence and manifests itself in several forms, including (1) small cell carcinoma, (2) carcinoid and carcinoid-like tumors, and (3) conventional adenocarcinoma with focal neuroendocrine differentiation. This latter pattern is the most common, and there is evidence that all or nearly all prostatic adenocarcinomas show at least some focal neuroendocrine differentiation. A review of the world's literature on this topic is included. Neuroendocrine differentiation generally portends a poorer prognosis but may also correlate directly with the grade. There is some evidence to suggest that neoplastic cells with neuroendocrine differentiation are resistant to hormonal therapy. Eutopic and ectopic hormone production may allow screening for prostatic carcinoma and/or monitoring for recurrence of prostatic carcinomas. Finally, the more basic implications of endocrine-paracrine cells and neuroendocrine differentiation are speculated on in reference to prostatic carcinogenesis and autocrine/paracrine tumor growth factor activity.

Paraganglioma of urethra

Paraganglioma of the urethra is a rare tumor; only 4 cases have been reported previously. We report a fifth case of urethral paraganglioma and review the literature.

Primary urinary cytodiagnosis of a bladder small-cell carcinoma

A small-cell undifferentiated tumor of the bladder in a 69-yr-old man with asymptomatic hematuria is described. Urine cytology showed abundant, small, round-to-oval hyperchromatic cells with coarse chromatin, nuclear molding, and high nuclear/cytoplasmic ratios. A primary cytodiagnosis of small-cell undifferentiated cancer with associated severe urothelial atypia was made. Immunohistochemical stains were negative for neuron-specific enolase, leukocyte common antigen, chromogranin, epithelial membrane antigen, prostatic acid phosphatase, and prostate-specific phosphatase. The diagnosis was confirmed histologically by studies performed on cystoscopic bladder biopsy material.

Primary carcinoid tumor of kidney. Light and electron microscopy, and immunohistochemical study

We present a case of primary renal carcinoid tumor with the appearance of type B carcinoid with trabecular and ribbon-like structure. All the immunohistochemical stains were negative. Electron microscopy revealed numerous cytoplasmic granules with polar distribution and masses of intermediate microfilaments. We believe only 8 cases have been reported in the literature.

Calcitonin immunoreactive cells in prostate gland and cloacal derived tissues

Calcitonin- and serotonin-storing cells have been immunocharacterized in prostate gland, urethra, urinary bladder and anal canal. In addition, a few hCG and somatostatin immunoreactive cells have been detected in prostate gland. All these cells were dispersed throughout the epithelial lining. In the anal canal, calcitonin cells were exclusively confined to the anal ducts and anal transitional zone epithelium. Calcitonin and serotonin cells were seen in some examples of prostatic adenocarcinoma. Combined techniques most often showed coexistence of calcitonin and serotonin immunoreactivities in the same endocrine cell. hCG immunoreactive cells corresponded to a subpopulation of serotonin-, calcitonin-storing cells. Calcitonin and serotonin cells were present in most organs which originated from the cloaca. In this territory, this distinctive endocrine pattern could be regarded as an excellent marker of cloacal derived tissues. These tissues constitute an additional site for extrathyroid C-cells. It is likely that calcitonin cells are a component of some prostatic adenocarcinomas.

Primary carcinoid tumor of urinary bladder

Invasive carcinoid tumor of the urinary bladder in a sixty-five-year-old man who presented with painless gross hematuria was documented by light and electron microscopic studies. The presence of 5-hydroxyindoleacetic acid (5-HIAA) and absence of vanillylmandelic acid (VMA) was determined in the neoplastic tissue by chemical analysis. This was consistent with the findings of elevated 5-HIAA and normal VMA in the twenty-four-hour urine sample. Sections of the tumor yielded negative argentaffin and argyrophil reactions. The relevant literature is reviewed.

Endocrine cells in median raphe cysts of the penis

Serotonin-storing cells are distributed in all tissues derived from cloaca. They were observed in the cavernous portion of penile urethra whereas they were absent from the glans portion. Serotonin cells were detected in several morphologic varieties of median raphe cysts. It is suggested that these cysts arise from the endodermal part of urethra.

Endocrine cells in the prostate gland, urothelium and Brenner tumors. Immunohistological and ultrastructural studies

Endocrine cells are a normal constituent of the prostate gland, prostatic urethra and urinary bladder mucosa. Positive results using immunohistochemical technics were obtained only with antiserotonin antibodies. In normal tissues, there was a close similarity between the distribution of argyrophilic cells (Grimelius) and serotonin-storing cells. Some striking features were the patchy distribution of endocrine cells, the presence of slender cytoplasmic processes occasionally reaching the luminal surface and the paucity of specialized cells in bladder mucosa. It is unlikely that endocrine cells participate in conventional neoplasms of prostate and bladder. Exceptions are lobular hyperplasia, certain adeno-carcinomas of prostate and inverted papilloma of bladder. An ultrastructural study permitted the distinction of two types of endocrine cells characterized by a different morphology of their granules. Another relevant finding was the presence of serotonin-storing cells in Brenner tumors. The latter observation emphasizes the close similarity between this neoplastic epithelium and urothelium. This implies that endocrine cells may be of mesodermal derivation.

Carcinoidal tumor of the kidney

Two cases of primary renal carcinoidal tumor are reported. One was discovered in a 32-year-old pregnant woman. The other tumor was retrospectively diagnosed 3 years after nephrectomy in a 65-year-old woman who was hospitalized with a metastatic lesion in her lumbar spine. Both tumors are compared with 5 other cases previously reported in the literature, and hypotheses about the cause of renal localization of this tumor are reviewed.

Neurosecretory granules in small cell invasive carcinoma of the urinary bladder

A 69-year-old man showed symptoms of urinary bladder irritability and hematuria. Cystoscopy and radiographic studies revealed a tumor within a bladder diverticulum. The tumor shared histologic and ultrastructural features with oat cell carcinoma of the lung, including the presence of small numbers of neurosecretory type granules. In spite of conservative surgical treatment, there has been no evidence of recurrent or metastatic tumor over 14 months of follow-up. Hypophosphatemia was present preoperatively, but resolved spontaneously after tumor resection. In regard to histogenesis, a metaplastic origin is favored. This appears to be the first reported case of a neoplasm of Kultschitzky-type cells arising in the urinary bladder.

Carcinoid tumor of the prostate associated with adenocarcinoma

A case of carcinoid tumor associated with adenocarcinoma arising in the prostate was studied. The results confirmed the presence of argentaffin cells. The significance of their presence and relationship to functional adenocarcinoma of the prostate are discussed.

Complete liver dearterialization and the carcinoid syndrome

A variety of surgical procedures are available in the treatment of the carcinoid syndrome, the aim being the destruction of liver secondaries and amelioration of symptoms. Dearterialization of the liver may be considered when liver secondaries are extensive and medical treatment inadequate in controlling symptoms. The patient reported here had severe symptoms of epigastric pain, anorexia, flushing, diarrhoea and recurrent syncope and was generally deteriorating rapidly. Complete dearterialization of the liver, however, resulted in a dramatic improvement. Now, 2 years later, the patient's hepatic scan, liver function tests and 24-h urine 5-hydroxyindolacetic acid (5-HIAA) are all within normal limits. Destruction of liver secondaries by dearterialization is a relatively simple procedure. Careful attention should be paid to large quantities of pharmacologically active compounds released from the liver during the procedure. Ascites, jaundice and liver cell failure are definite contraindications to surgery.

Primary carcinoid of prostate

The first case of pure primary prostatic carcinoid is presented. Previous demonstration of the presence of enterochromaffin cells in the non-neoplastic prostate and in otherwise ordinary adenocarcinomas of the prostate furnishes a basis for the origin of this unique neoplasm.