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Renavikar PS, Auen TJ, Wagner DG, Lele SM. Mucin-producing urothelial-type adenocarcinoma of the prostate with sarcomatoid features and novel molecular phenotype. IJU Case Rep 2024; 7:77-82. [PMID: 38173453 PMCID: PMC10758892 DOI: 10.1002/iju5.12672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/08/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Mucin-producing urothelial-type adenocarcinoma of the prostate is a rare tumor that may not elevate serum prostate-specific antigen, creating significant diagnostic and monitoring challenges. We evaluate our case in detail and review prior studies to demonstrate that the pathologic and molecular features of this tumor are distinct from conventional prostate adenocarcinoma. Case presentation Our patient had a remote history of radiation-treated conventional prostate adenocarcinoma and presented many years later with an abscess-like prostate mass leading to urinary obstruction and hematuria. Biopsy revealed mucin-producing urothelial-type adenocarcinoma of the prostate with concurrent sarcomatoid features. Molecular studies showed a unique phenotype involving alterations in the KRAS, PTEN, RAD21, and TP53 genes. Conclusions To our knowledge, this is the first report that describes sarcomatoid features and molecular mutations in mucin-producing urothelial-type adenocarcinoma of the prostate.
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Affiliation(s)
- Pranav S Renavikar
- Department of Pathology and MicrobiologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Thomas J Auen
- Department of Pathology and MicrobiologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - David G Wagner
- Department of Pathology and MicrobiologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Subodh M Lele
- Department of Pathology and MicrobiologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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Nova-Camacho LM, Villafruela Mateos A. A Rare Case of Co-Existing Mucin-Producing Urothelial-Type Adenocarcinoma of the Prostate and Acinar Adenocarcinoma. Int J Surg Pathol 2022:10668969221105624. [PMID: 35903905 DOI: 10.1177/10668969221105624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mucin-producing urothelial-type adenocarcinoma of the prostate is an extremely rare neoplasm, and its coexistence with acinar adenocarcinoma is exceptional. A 70-year-old man presented with treatment resistant symptoms of urinary obstruction. The serum prostate specific antigen (PSA) level was normal. Cystoscopy revealed a kind of "cottony fluff" in the prostatic urethra. A computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a polylobulated, hyperintense lesion with mucinous content. It was located in the right lobe of the prostate and measured 35 × 27 × 35 mm. The bladder cavity did not show lesions and the gastrointestinal endoscopy was normal. Thus, the patient underwent a radical cystoprostatectomy. The histological sections showed the characteristics of a mucin-producing adenocarcinoma with extensive areas of mucin pools formation. No areas of necrosis, glandular urethritis, or carcinoma in situ were identified. Neither lymphovascular and perineural invasion nor lymph node metastases were identified. The immunohistochemical study showed diffuse positivity for keratin (KRT) 7, KRT20, and membranous beta-catenin and focal positivity for KRT34betaE12 and caudal-related homeobox gene 2 (CDX2). In addition, we identified a 10-mm focus of prostatic acinar adenocarcinoma that was positive for racemase and NKX3.1. There is no treatment algorithm for this condition; however, surgery (radical prostatectomy) with or without adjuvant chemotherapeutic treatment represents a therapeutic alternative.
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Affiliation(s)
- Luiz M Nova-Camacho
- Department of Pathology, 16650Hospital Universitario Donostia, San Sebastian, Spain
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Shimizu K, Inoue R, Tomochika S, Isoyama N, Yamamoto Y, Matsumoto H, Shiraishi K, Yoshino S, Tsuzuki T, Matsuyama H. Mucin-producing urothelial-type adenocarcinoma of the prostate diagnosed after robot-assisted radical prostatectomy. IJU Case Rep 2022; 5:32-35. [PMID: 35005467 PMCID: PMC8720726 DOI: 10.1002/iju5.12380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/07/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Mucin-producing adenocarcinoma of the prostate is a rare disease that includes prostate adenocarcinoma with mucus production, secondary adenocarcinoma from the bladder or colorectum, and adenocarcinoma from the urothelium of the prostatic urethra. We describe prostate-specific antigen-negative mucin-producing urothelial-type adenocarcinoma of the prostate. CASE PRESENTATION The patient had urinary retention and a serum prostate-specific antigen level of 0.74 ng/mL. Computed tomography and magnetic resonance imaging revealed a prostate tumor with a mucous component. We diagnosed adenocarcinoma by prostate biopsy and subsequently performed robot-assisted radical prostatectomy. Mucin-producing urothelial-type adenocarcinoma of the prostate was diagnosed by pathological examinations. Lung metastasis, developing within 3 months after surgery, was treated using chemotherapy. CONCLUSION Endocrine therapy is ineffective for mucin-producing urothelial-type adenocarcinoma of the prostate. Mucin-producing urothelial-type adenocarcinoma of the prostate diagnosis requires pathological and immunohistochemical analyses. It is important to surgically remove the primary lesion, and robot-assisted radical prostatectomy may provide an effective approach. Multimodal therapy is essential to treat for mucin-producing urothelial-type adenocarcinoma of the prostate.
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Affiliation(s)
- Kosuke Shimizu
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Ryo Inoue
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Shinobu Tomochika
- Department of GastroenterologicalBreast and Endocrine SurgeryGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Naohito Isoyama
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Yoshiaki Yamamoto
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Hiroaki Matsumoto
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | - Koji Shiraishi
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
| | | | - Toyonori Tsuzuki
- Department of Surgical PathologySchool of MedicineAichi Medical UniversityNagakuteJapan
| | - Hideyasu Matsuyama
- Departments of UrologyGraduate School of MedicineYamaguchi UniversityUbeJapan
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Peak TC, Goodman MM, Fenu EM, Hemal AK. Mucinous adenocarcinoma of the prostatic urethra following a remote history of primary brachytherapy for prostate cancer. SAGE Open Med Case Rep 2020; 8:2050313X20959867. [PMID: 33088568 PMCID: PMC7543121 DOI: 10.1177/2050313x20959867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022] Open
Abstract
Secondary malignancies are a known, albeit uncommon, complication of radiation for prostate cancer, either in the form of external beam radiotherapy or seed-implant brachytherapy. Of these secondary malignancies, mucinous adenocarcinoma of the prostatic urothelium is an extremely rare clinical entity that has only once been reported in the literature. We report the case of an 80-year-old gentleman who initially underwent low-dose brachytherapy for low-risk prostate cancer 18 years ago. He subsequently developed recurrent gross hematuria and obstructive voiding symptoms. He underwent cystoscopy and transurethral resection of a large tumor from within the prostate. Final pathology of the tumor revealed a mucinous adenocarcinoma. Further immunostaining revealed this is likely to have originated from the prostatic urothelium. Given his age, comorbidities, and no clear data demonstrating that aggressive extirpative surgery provides a clinical benefit, we elected to undergo surveillance. Clinicians should be aware of mucinous adenocarcinoma of the prostatic urethra as an extremely rare, radiation-induced malignancy. Once a diagnosis is made, extirpative surgery is an option for localized disease, although prognosis remains poor.
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Affiliation(s)
- Taylor C Peak
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Michael M Goodman
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elena M Fenu
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.,Department of Urology, Comprehensive Cancer Center, Robotics and Minimally Invasive Surgery, and Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
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6
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Solakhan M, Erturhan MS, Sevinç A, Çetin S. Aggressive course in a patient with mucin-producing urothelial-type adenocarcinoma of the prostate: A case report and review of the literature. Turk J Urol 2018; 45:S135-S138. [PMID: 32027595 DOI: 10.5152/tud.2018.30837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/16/2018] [Indexed: 01/14/2023]
Abstract
Prostate cancer is one of the frequently seen types of cancers in men. The most frequent histological type of prostate cancer is the acinar adenocarcinoma. Mucin-producing urothelial-type adenocarcinoma of the prostate is a very rare subtype. The mucin-producing urothelial-type adenocarcinoma of the prostate has microscopic similarities with colon and bladder adenocarcinoma. It has a more aggressive clinical course and does not respond to androgen deprivation therapy. A 77-year-old male patient diagnosed with mucinous prostate cancer was presented in the current case report.
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Affiliation(s)
- Mehmet Solakhan
- Department of Urology, Bahçesehir University School of Medicine, Gaziantep Medicalpark Hospital, Gaziantep, Turkey
| | | | - Alper Sevinç
- Department of Medical Oncology, Gaziantep Medicalpark Hospital, Gaziantep, Turkey
| | - Safiye Çetin
- Department of Pathology, Special Patolab Center, Antalya, Turkey
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Co-existence of mucin-producing urothelial-type adenocarcinoma of the prostate and inverted papilloma of the bladder. Contemp Oncol (Pozn) 2017; 21:184-187. [PMID: 28947891 PMCID: PMC5611510 DOI: 10.5114/wo.2017.68629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 11/24/2013] [Indexed: 01/24/2023] Open
Abstract
Adenocarcinoma of prostate with mucinous differentiation arising in the male urethra is extremely rare, with only 21 cases reported in the previous literature. A diagnosis of mucin-producing urothelial carcinoma of the prostate is based on the pathology, immunohistochemistry, and clinical examination by excluding the secondary adenocarcinoma of the prostate. We present a case of unexpected mucinous urothelial carcinoma of prostate with co-existing inverted papilloma of bladder in a 57-year-old man. The patient underwent transurethral resection of the prostate (TURP) and transurethral resection of a bladder tumour (TUR-Bt), and the pathologic result showed mucinous prostate carcinoma and bladder inverted papilloma. Immunohistological stain was negative for prostate-specific antigen (PSA), prostate-specific acid phosphatase (PSAP), and P63, but positive for cytokeratin 7 (CK 7), CK 20, clone 34βE12 and P504S. A complete endoscopic examination was performed to exclude the secondary adenocarcinoma of prostate. This case illustrates the clinical and pathological features of a rare and unexpected mucin-producing urothelial carcinoma of prostate in a bladder neoplasm patient.
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Bryce AH, Borad MJ, Egan JB, Condjella RM, Liang WS, Fonseca R, McCullough AE, Hunt KS, Ritacca NR, Barrett MT, Patel MD, Young SW, Silva AC, Ho TH, Halfdanarson TR, Stanton ML, Cheville J, Swanson S, Schneider DE, McWilliams RR, Baker A, Aldrich J, Kurdoglu A, Izatt T, Christoforides A, Cherni I, Nasser S, Reiman R, Cuyugan L, McDonald J, Adkins J, Mastrian SD, Von Hoff DD, Craig DW, Stewart AK, Carpten JD. Comprehensive Genomic Analysis of Metastatic Mucinous Urethral Adenocarcinoma Guides Precision Oncology Treatment: Targetable EGFR Amplification Leading to Successful Treatment With Erlotinib. Clin Genitourin Cancer 2016; 15:e727-e734. [PMID: 28057415 PMCID: PMC7513310 DOI: 10.1016/j.clgc.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/20/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Alan H Bryce
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN.
| | - Mitesh J Borad
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Jan B Egan
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Rafael Fonseca
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Ann E McCullough
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | | | | | - Michael T Barrett
- Mayo Clinic Cancer Center, Phoenix, AZ; Translational Genomics Research Institute, Phoenix, AZ
| | | | - Scott W Young
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Alvin C Silva
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Thai H Ho
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Thorvardur R Halfdanarson
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | - John Cheville
- Department of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, MN
| | | | | | - Robert R McWilliams
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN; Mayo Clinic Cancer Center, Rochester, MN
| | - Angela Baker
- Translational Genomics Research Institute, Phoenix, AZ
| | | | | | - Tyler Izatt
- Translational Genomics Research Institute, Phoenix, AZ
| | | | - Irene Cherni
- Translational Genomics Research Institute, Phoenix, AZ
| | - Sara Nasser
- Translational Genomics Research Institute, Phoenix, AZ
| | | | - Lori Cuyugan
- Translational Genomics Research Institute, Phoenix, AZ
| | | | | | | | | | - David W Craig
- Translational Genomics Research Institute, Phoenix, AZ
| | - A Keith Stewart
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ; Mayo Clinic Cancer Center, Phoenix, AZ; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
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Mucin-producing tumors and tumor-like lesions involving the prostate: a comprehensive review. Adv Anat Pathol 2012; 19:374-87. [PMID: 23060063 DOI: 10.1097/pap.0b013e318271a361] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Mucin-producing tumors of the prostate include both primary and secondary tumors with mucinous differentiation or features involving the prostate gland. These tumors are relatively rare and have variable prognostic and therapeutic implications. Primary mucinous (colloid) adenocarcinoma of the prostate is defined as prostatic adenocarcinoma with mucinous differentiation involving 25% or more of the entire tumor. Another primary tumor of the prostate that may have mucinous features is primary mucin-producing urothelial-type adenocarcinoma of the prostate (mucinous prostatic urethral adenocarcinoma). Primary mucin-producing urothelial-type adenocarcinoma of the prostate is a distinct entity that typically arises from the prostatic urethra possibly from urethritis glandularis or glandular metaplasia with malignant transformation, and it is analogous to adenocarcinoma with mucinous differentiation arising from the urinary bladder. Signet ring cell tumors of the prostate, though rare, may also have mucinous features. Secondary tumors with mucinous differentiation that may involve the prostate include adenocarcinomas of the urinary bladder and colorectum. Pathologists should also be aware of mucin-producing tumor-like lesions involving the prostate, including mucinous metaplasia, and benign Cowper glands that may mimic malignancy. Herein we present an updated and comprehensive review of the clinicopathologic, immunohistochemical, molecular, and prognostic features of mucinous tumors and tumor-like lesions involving the prostate gland, with emphasis on mucinous prostatic adenocarcinoma and its mimickers, including potential diagnostic pitfalls.
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Chen YL, Chian JH, Hsiao PJ. Mucin-producing urothelial-type adenocarcinoma of the prostate as a mimicker of colonic adenocarcinoma: a case report and review of the literature. Int J Surg Pathol 2011; 20:191-5. [PMID: 21791488 DOI: 10.1177/1066896911414272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 59-year-old man presented with persistent urinary obstructive symptoms, gross hematuria, and mucusuria. Subsequently, a prostate-specific antigen (PSA)-negative mucin-producing urothelial type adenocarcinoma of prostate was found. The serum PSA level was within the normal limit. Colonoscopy, positron emission tomography, and other tumor surveys showed this to be the only prostate lesion. Microscopically, there was an adenocarcinoma with copious mucin production, with the formation of mucin pools. The neoplastic glands were variously arranged in cribriform, glandular, and villous adenoma-like patterns. This is a very rare tumor, of which there are only 20 cases reported in the literature in the English language. It is critical to distinguish it from mucinous acinar adenocarcinoma of the prostate and from metastatic adenocarcinoma of either the bladder or colon. This is mainly because mucin-producing urothelial type adenocarcinoma of the prostate has a different clinical behavior, and hence, the treatment plan is different from that for conventional prostatic adenocarcinoma. Specifically, it has a more aggressive clinical course and is unresponsive to hormone therapy.
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Affiliation(s)
- Yen-Lin Chen
- Department of Pathology, Cardinal Tien Hospital, Medical School, Fu Jen Catholic University, Taipei, Taiwan
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