Cystic epithelial-stromal tumor of the seminal vesicle

Massive mixed epithelial-stromal tumour of seminal vesicle requiring challenging abdominoperineal resection: a case report and review of literature

Mixed epithelial-stromal tumours (MESTs) are a rare biphasic tumour that frequently arise in women from the renal and urogenital tract. They are also seen in men but are exceptionally uncommon with only few cases reported to originate from the seminal vesicles. Malignant transformation of its epithelial or stromal components is possible; however, by in large, these tumours are benign in nature. We report the case of a 48-year-old man with no remarkable medical or surgical history who presented with a huge expanding pelvic and intra-abdominal mass that required extensive surgical management including a pelvic exenteration. Histopathological analysis concluded the diagnosis of benign MEST originating from the seminal vesicles with no malignant features. No further systemic therapy was recommended for our patient. Given the technical intricacy in the operative resection of this tumour, we aim to present our findings and surgical management of this complex MEST.

Cystadenoma of the seminal vesicle – Potential diagnostic pitfall: A case report and literature review

Background:

Cystadenomas of the seminal vesicles are benign cystic tumours, currently classified into the group of mixed epithelial-stromal tumours (MEST). Primary tumours arising in the seminal vesicles are quite rare, benign tumours being rarer than malignant ones, with only a few cases reported in the English literature since 1944. Cystadenomas represent a potential diagnostic pitfall, as they can be clinically confused with malignant neoplasms and histologically with non-neoplastic inflammatory lesions or other cystic tumours, even malignant.

Objective and methods:

We report a case of a 23-year-old man presenting with a cystic mass of the seminal vesicle, clinically suspected to be a malignant neoplasm. On pathological examination, a diagnosis of cystadenoma was made. Diagnostic criteria to make a diagnosis of this tumour are questionable. Therefore, we carried out a literature review in attempt to compare clinico-pathological findings of 28 cases reported in the English literature as cystadenomas of the seminal vesicle.

Results:

Only 28 cases of cystadenomas of seminal vesicles were reported in the English literature. The available data show the difficulty to rule out malignancy preoperatively in a patient with a solid-cystic mass in the pelvic region, and that morphological findings observed were often reported incompletely.

Conclusions:

The current classification appears debatable, as well as histopathological criteria to diagnose a cystadenoma of the seminal vesicle. For the proper management of these lesions, a multidisciplinary approach is mandatory.

Level of evidence:

Not applicable

Cystic papillary adenoma of the seminal vesicle

Background

Primary Seminal Vesicle (SV) tumours are a rare entity, with most SV masses representing invasion of the SV by malignancy originating in an adjacent organ, most often the prostate. Previously reported primary SV epithelial tumours have included adenocarcinoma and cystadenoma, with limited prior reports of inracystic papillary structures.

Case presentation

A 35-year-old male presented with azoospermia, intermittent macroscopic haematuria, and mild right iliac fossa and groin pain. A papillary appearing seminal vesicle mass was found on imaging and seminal vesicoscopy. The mass was robotically excised with diagnosis of benign cystic papillary adenoma made.

Conclusion

In this manuscript we describe a rare case of a benign cystic papillary adenoma of the seminal vesicle, a unique histological entity differentiated from cystadenoma of the Seminal Vesicle by its papillary component.

Laparoscopic resection of a large mixed epithelial-stromal tumour of the seminal vesicle: a rare entity and review of the current literature

Mixed epithelial-stromal tumours (MESTs) of the seminal vesicle (SV) are a rare neoplasm, with biological behaviour ranging from benign to malignant. Due to their rarity, there are no established guidelines for their treatment. We report a 37-year-old man with a large MEST of the SV which was successfully resected by laparoscopic transperitoneal approach. Amidst the controversy regarding the nomenclature and grading of MESTs in literature, we reclassified the previous reports of MESTs incorporating both the WHO and Reikie et al grading.

Robot-assisted laparoscopic vesicule prostatectomy for mixed epithelial-stromal tumor of seminal vesicle

INTRODUCTION

Mixed epithelial-stromal tumor is a biphasic tumor with stromal and benign epithelial components. Only 40 cases of mixed epithelial-stromal tumor originating from a seminal vesicle have previously been published in English.

CASE PRESENTATION

A 52-year-old man was transferred to our hospital for evaluation of a 3.0-cm pelvic tumor detected incidentally by computed tomography. Robot-assisted laparoscopic vesicle prostatectomy was performed. We approached the Retzius space from both levels of the pouch of Douglas and peritoneal top of the bladder to clarify the tumor's environment. Pathologically, the tumor was diagnosed as a low-grade mixed epithelial-stromal tumor originating from the right seminal vesicle. There was no evidence of disease recurrence within 51 months.

CONCLUSION

This is the first report of robot-assisted laparoscopic vesicle prostatectomy for a seminal vesicle mixed epithelial-stromal tumor. Long-term observation is warranted due to the lack of reports with sufficient follow-up to ensure the procedure's safety.

Laparoscopic vesiculectomy for large seminal vesicle cystadenoma

Cystadenomas of the seminal vesicles are extremely rare. Here, we report a large seminal vesicle cystadenoma. A 37-year-old man presented a 6-month history of haemospermia, 10 days of Lower Urinary Tract symptoms (LUTSs) and gross haematuria. Transabdominal ultrasonography, computed tomography and magnetic resonance imaging were performed and revealed a large solid-cystic pelvic mass morphometrically measured 7.0 cm × 11.9 cm × 8.6 cm on the right seminal vesicle, which caused hydronephrosis of the right kidney. The prostate-specific antigen of the patient was 27.860 ng/dl. Laparoscopic exploration found the capsule of tumour was complete and the tumour came from the right seminal vesicle, in addition, the mass had a certain space with the bladder and prostate, which could be separated. So a nerve-sparing Laparoscopic Vesiculectomy was performed at last, even though the intraoperative frozen section analysis could not make sure the nature of the tumour either. The postoperative pathology revealed cystadenoma of the seminal vesicle.

Rare primary malignant mixed Müllerian tumor of the mediastinum: A case report

RATIONALE

Malignant mixed Müllerian tumor (MMMT) of extragenital organs is rare, especially in male. To our knowledge, this is the first reported case of primary MMMT at the mediastinum in male.

PATIENT CONCERNS

A 54-year-old male was admitted to the hospital due to repeated stimulating dry cough for 2 years. His systemic examination was unremarkable. Laboratory workup revealed that all blood indicators were within normal limits. But subsequent computerized tomography (CT) scans of chest showed an abnormal soft tissue density in the area of its left, measuring approximately 4 cm in anterior-posterior dimension and 7 cm in maximum transverse dimension.

DIAGNOSES AND INTERVENTIONS

The pathogenesis of these tumors remains controversial. The diagnosis is combined with biopsy and immunohistochemical staining. So, the patient underwent radical surgical resection and pathologic examination of the excised specimen was consistent with the diagnosis of MMMT. After surgery, he was treated by sequential chemoradiotherapy.

OUTCOMES

The patient died from tumor recurrence 16 months later.

LESSONS

MMMT is a rare, highly aggressive tumor associated with interesting embryological origin, a definite diagnosis of which is only confirmed on pathological assessment. Due to its high degree of malignancy and high rate of recurrence, complete macroscopic excision of the tumor is recommended as soon as possible.

Müllerian Adenosarcoma of the Urinary Bladder: Clinicopathologic and Immunohistochemical Features With Novel Genetic Aberrations

BACKGROUND

Müllerian adenosarcoma is a biphasic neoplasm most commonly occurring in the uterus and less frequently of the ovary. It has been rarely described to occur in other sites such as peritoneum and liver.

PATIENTS AND METHODS

In this study, we report the clinicopathologic, immunohistochemical and molecular features of a primary Müllerian adenosarcoma of the urinary bladder in a 62-year-old woman. To our knowledge, this is the first report of detailed pathologic characterization of Müllerian adenosarcoma primary to the urinary bladder in the literature.

RESULTS

Light microscopy showed a biphasic epithelial and stromal tumor with benign-appearing glands surrounded by densely cellular endometrial-type stroma that is densely cellular with increased mitotic figures. The stroma surrounding the glands was more cellular than the intervening areas, which were more loose and edematous. Immunohistochemistry staining revealed positive staining for Pax-2/8 within the glands, for positive CD10 and WT-1 within the spindle cell stroma, and for estrogen and progesterone receptors in both. Staining for desmin, GATA3, p63, and human papillomavirus was negative. Molecular analyses identified mutations in protein kinase B E17K, fms related tyrosine kinase 3 D835N, KRAS proto-oncogene, GTPase G12D, and HRAS proto-oncogene, GTPase G12S. These novel molecular aberrations have yet to be reported in the medical literature. X chromosome inactivation analysis revealed a clonal pattern in the stromal component and a nonclonal pattern in the epithelial component. Currently, the patient is disease/recurrence-free after regular follow-up of approximately 84 months.

CONCLUSION

This case represents, to our knowledge, the first reported diagnosis of Müllerian adenosarcoma arising in the urinary bladder with extensive clinicopathologic, immunohistochemical, and molecular analyses.

Mixed epithelial-stromal tumor (MEST) of seminal vesicle: a proposal for unified nomenclature

In contrast to the common tumors of the prostate, seminal vesicle demonstrates low potential for neoplastic proliferation. Of the rare primary seminal vesicle tumors, adenocarcinoma is the most common, but there are also rare seminal vesicle neoplasms which demonstrate epithelial and stromal components. These neoplasms have been described in the literature under various names, including "epithelial-stromal tumor," "cystic epithelial-stromal tumor," "cystadenoma," "cystomyoma," "mesenchymoma," "Müllerian adenosarcoma-like tumor," "phyllodes tumor," and "cystosarcoma phyllodes." The spectrum of reported mixed epithelial-stromal tumors (MEST) of seminal vesicle encompasses low, intermediate and high-grade tumors, but the precise distinction and nomenclature for these tumors remain unsettled. We propose a common nomenclature for these tumors, based on the review of published cases and 2 index cases from our practice, which represent the low-grade category. The first patient was 46 years old and presented with seminal vesicle neoplasm detected on routine rectal examination. The neoplasm measured 4 cm in greatest dimension, and completely replaced the left seminal vesicle. The tumor was circumscribed and consisted of multiple cysts separated by spindle-cell stroma. The second patient was a 60-year-old man, who had an incidental seminal vesicle neoplasm, which was discovered when he underwent a radical prostatectomy for a prostatic adenocarcinoma, (Gleason score 3+4, stage 3a). Both neoplasms contained hypercellular stroma, which was composed of uniform spindle cells, arranged in fascicles and interspersed between the glands. Both tumors lacked worrisome morphology, such as infiltrative borders, cell atypia, increased mitotic activity, hemorrhage, and necrosis. The stromal cells were reactive for estrogen and progesterone receptors, and desmin. The cysts and dilated glands were lined by epithelial cells, which were positive for cytokeratin 7 and were negative for prostate-specific antigen and prostate-specific acid phosphatase. The first patient underwent prostatectomy and was alive and without evidence of disease recurrence or progression after 11 years of follow-up. Similarly, the second patient had no evidence of disease recurrence or progression after 8 months of follow-up. We propose that term seminal vesicle "mixed epithelial-stromal tumor" be used to designate the tumors of the seminal vesicle containing epithelial and stromal components, with a distinction of grade based on the histologic features and the biological behavior. Histologic features to be evaluated for grade separation include stromal atypia, mitotic activity, nuclear pleomorphism, and tumor necrosis. Designations "low-grade MEST," "intermediate-grade MEST (uncertain malignant potential)," and "high-grade MEST" of seminal vesicle can be applied to these tumors to better characterize and study them in the future.

Mesenchymal tumours of the bladder and prostate: an update

Mesenchymal tumours of the urinary bladder and prostate are infrequent neoplasms. The body of literature is growing with isolated case reports and short series, and the majority of cases are benign neoplasms. Other than stromal tumour of uncertain malignant potential and prostatic stromal sarcoma, both neoplasms derived from the specific prostatic stroma, the mesenchymal neoplasms in these locations are identical to their counterparts seen in other organs. However, the limited amount of tissue generated by biopsy and rarity of mesenchymal lesions in these sites create unique diagnostic difficulties, while correct classification of the neoplasm often bears significant impact on prognosis and therapeutic strategy. In this review we summarise the diagnostic features, focus on the differential diagnosis, and highlight the potential diagnostic pitfalls of mesenchymal tumours of the bladder and prostate.

Seminal vesicle cystadenoma: a rare clinical perspective

A 52-yr-old man presented with severe obstructive urinary symptoms. Ten years earlier, a digital rectal examination disclosed a small mass above the prostate, and a computed tomography (CT) scan showed a 3.5-cm cystic tumor of the right seminal vesicle. He had been followed conservatively elsewhere. Reevaluation of the mass with a CT scan and magnetic resonance imaging showed that the mass had grown to a maximal diameter of 14 cm. A transabdominal needle biopsy revealed benign fibromuscular tissue. The tumor was then resected by an open transvesical approach. Pathology was consistent with a benign seminal vesicle cystadenoma. The natural history, pathology, and surgical approach are described.

Low grade epithelial stromal tumour of the seminal vesicle

Background

The mixed epithelial stromal tumour is morphologically characterised by a mixture of solid and cystic areas consisting of a biphasic proliferation of glands admixed with solid areas of spindle cells with variable cellularity and growth patterns. In previous reports the seminal vesicle cystoadenoma was either considered a synonym of or misdiagnosed as mixed epithelial stromal tumour. The recent World Health Organisation Classification of Tumours considered the two lesions as two distinct neoplasms. This work is aimed to present the low-grade epithelial stromal tumour case and the review of the literature to the extent of establishing the true frequency of the neoplasm.

Case presentation

We describe a low-grade epithelial stromal tumour of the seminal vesicle in a 50-year-old man. Computed tomography showed a 9 × 4.5 cm pelvic mass in the side of the seminal vesicle displacing the prostate and the urinary bladder. Magnetic resonance was able to define tissue planes between the lesion and the adjacent structures and provided useful information for an accurate conservative laparotomic surgical approach. The histology revealed biphasic proliferation of benign glands admixed with stromal cellularity, with focal atypia. After 26 months after the excision the patient is still alive with no evidence of disease.

Conclusion

Cystoadenoma and mixed epithelial stromal tumour of seminal vesicle are two distinct pathological entities with different histological features and clinical outcome. Due to the unavailability of accurate prognostic parameters, the prediction of the potential biological evolution of mixed epithelial stromal tumour is still difficult. In our case magnetic resonance imaging was able to avoid an exploratory laparotomy and to establish an accurate conservative surgical treatment of the tumour.

Epithelial-stromal tumor of seminal vesicle in a patient with chromophobe renal cell carcinoma and small lymphocytic lymphoma

Biphasic tumors of the seminal vesicle are rare. We report a further case in a 61-year-old man of a seminal vesicle epithelial-stromal tumor with focally atypical epithelial and stromal cells, the latter displaying a smooth muscle immunophenotype. In addition, this was associated with 2 synchronous malignant neoplasms, chromophobe renal cell carcinoma and small lymphocytic lymphoma, both of which were detected incidentally after clinical presentation because of the seminal vesicle mass.

Retained products of conception mimicking a large endometrial AVM: complete resolution following spontaneous abortion

We report an unusual appearance of retained products of conception that mimicked an arteriovenous malformation. A 38-year-old woman presented with persistent scant vaginal bleeding and declining levels of serum beta-HCG after therapeutic abortion. Sonographic examination revealed a highly vascular lobulated mass, which on spectral Doppler examination showed low resistance and high peak systolic velocity suggestive of arteriovenous shunting. The patient spontaneously passed tissue per vagina, after which the endometrial vascular mass completely disappeared, indicating that the sonographic abnormality was the retained products of conception. The pathologic basis for such a finding is discussed.

Multilocular cystadenoma and cystadenocarcinoma of the prostate

BACKGROUND

Multicystic prostatic tumors are rare, with only a few reported cases of prostatic cystadenoma and cystadenocarcinoma in the scientific literature.

METHODS

A retrospective review of our tumor registry over the last 25 years identified 2 rare cystic tumors of the prostate: 1 multilocular cystadenoma and 1 multilocular cystadenocarcinoma.

RESULTS

The first case illustrates the clinical and pathologic features of prostatic multilocular cystadenoma. A 42-year-old man presented with a 16-cm suprapubic mass causing displacement of adjacent visceral organs. Pathologic examination after prostatectomy confirmed it to be a multilocular cystadenoma of the prostate. The patient's postoperative course was uneventful, and his serum prostate-specific antigen level remained at < or =0.04 ng/ml throughout the course of his disease. In the second case, we present an 80-year-old male presenting with a 12-cm cystic mass of the prostate. His serum prostate-specific antigen level remained at > or =9.0 ng/ml throughout the course of his disease. The tumor had an aggressive local growth pattern, with invasion into perirectal adipose tissue. This patient underwent a pelvic exenteration, followed by adjuvant systemic chemotherapy and complete androgen blockade. Despite aggressive treatment, he had 3 recurrences over 4 months but remains alive with disease at 23-month follow-up.

CONCLUSIONS

Cystadenocarcinoma of the prostate is locally aggressive and should be included in the differential diagnosis of cystic lesions of the prostate.

Cystadenoma of the seminal vesicle

Primary tumors of the seminal vesicle are quite rare with most reported cases being carcinomas. However, benign tumors of the seminal vesicle are extremely rare. We report a case of a cystadenomas of the seminal vesicles in a 46-year-old asymptomatic man, which was detected incidentally by computed tomography.

Epithelial stromal tumor of the seminal vesicle

Primary tumors of the seminal vesicles are rare neoplasms; there have been only 69 accepted cases. The histologic features are usually adenocarcinoma; however, there are rarely reported epithelial stromal tumors of the seminal vesicles. We report a case of a 70-year-old man with an epithelial stromal tumor of the seminal vesicle who presented without symptoms of bladder outlet obstruction. The patient underwent radical cystoprostatectomy. No signs of tumor recurrence were noted within 14 months of surgery. To our knowledge, 13 cases of epithelial stromal tumors of the seminal vesicle have been previously reported.

Epithelial-stromal tumor of the seminal vesicles in the transgenic adenocarcinoma mouse prostate model

The transgenic adenocarcinoma mouse prostate (TRAMP) model, designed for researching human prostatic cancer, was genetically engineered to harbor a transgene composed of the simian virus 40 Large-T/small-t antigen promoted by the rat probasin gene. In addition to prostatic neoplasms, the TRAMP mouse develops tumors in the seminal vesicles. This study was conducted to evaluate the pathology and histogenesis of TRAMP seminal vesicle neoplasms. Tissues of accessory sex organs harvested from 72 TRAMP mice of various ages (11-40 weeks of age) were fixed in neutral buffered formalin and stained with hematoxylin and eosin, desmin, 5-bromo-2'-deoxyuridine (BrdU, treated animals only), and SV40 Large-T antigen (SV40-Tag). In the seminal vesicles, we found neoplastic stromal cells that emerged multicentrically just beneath the epithelium, densely packed between the epithelium and the smooth muscle layer. These stromal cells frequently exhibited mitotic figures and showed BrdU incorporation and SV40-Tag protein expression in the nuclei and immunopositivity for desmin. The proliferative mesenchymal cells were lined by cuboidal to columnar epithelium. Some of the larger papillary, polypoid lesions exhibited a phyllodes pattern resembling that seen in mixed epithelial-stromal tumors of the breast, prostate, and seminal vesicles of humans. Although the epithelium was negative for SV40-Tag and showed only occasional incorporation of BrdU, it clearly participated in the biphasic proliferation, forming papillary, cystic, and tubuloglandular structures. No conclusive evidence of malignancy (invasion or metastasis) was identified. Our recommended diagnosis of this lesion in the seminal vesicles is epithelial-stromal tumor.

Mesodermal Adenosarcoma of the Testis

Biphasic neoplasms with a benign to atypical epithelial component and a usually low-grade malignant stromal component have been reported in various sites, probably being best known for their occurrence in the uterine corpus (mullerian adenosarcoma). We report a tumor of this type that occurred in the testis of a 76-year-old man and, to our knowledge, is the first mesodermal adenosarcoma reported at this site. The patient had scrotal swelling for many years with a pronounced increase in the swelling over the past 2 years. A large complex solid-cystic testicular tumor was evident on ultrasound, and examination of a radical orchiectomy specimen showed a 6.5-cm mass. On microscopic examination, the neoplasm had a phyllodes-like appearance with bland cuboidal to flattened epithelium covering polypoid fronds, and lining glands and cysts. The stroma varied from cellular, particularly where it condensed around the glands and cysts, to hypocellular and hyalinized. It was immunoreactive for muscle specific actin, CD10, and to a lesser degree, desmin. This case expands the known sites where mesodermal adenosarcoma may occur. The histogenesis is speculative, but possible options are discussed.

Phyllodes tumor of the seminal vesicle: Case report and literature review

A 39-year-old man presented with urinary retention and lower abdominal discomfort at our hospital, and a computed tomography scan showed a huge cystic mass posterior to the urinary bladder. During surgical exploration, a mass superior to the prostate in the region of the left seminal vesicle was found. Histologically, the tumor was characterized by cystically dilated or slit-like glands mixed in a densely cellular stroma with pleomorphism and resembled those of phyllodes tumor of the breast or prostate. The glandular epithelium within the tumor showed focal lipofuscin pigment and negative staining for prostate specific antigen (PSA). The stromal cells showed positive immunoreactivity for vimentin and CD34, and focal positive reactions for desmin and alpha-smooth muscle actin. Mitosis was present 0 to 1 per 10 high power fields of magnification in the stromal cells. Approximately 20% of the stromal cells were positive for progesterone receptor. The patient is alive with no evidence of disease 12 months after surgery. Mixed epithelial-stromal tumors of the seminal vesicle are extremely rare. A combination of stromal cellularity, atypia and mitosis might be used for the histological grading, and a prostatic origin might be excluded by the location of the primary lesion itself and by the failure to show PSA.

Cystosarcoma phyllodes of the prostate with rhabdomyoblastic differentiation

A 36-year-old man presented with recurrent urinary obstruction and an enlarged, partially cystic prostate tumour on ultrasonography. Microscopically, the tumour was composed of cystically dilated ducts with leaf-like stromal projections in the lumen. A portion of the stroma was very cellular with atypia and a high mitotic rate. In addition, there was a small focus with well differentiated rhabdomyoblasts. This case is the second description of a cystosarcoma phyllodes of the prostate with rhabdomyoblasts differentiation. With radical surgery and chemotherapy only partial remission could be obtained.

Seminal vesicle cystadenoma: a case report and literature review

Primary tumors of the seminal vesicle are rare; most reported cases are carcinomas, with occasional reports of primary seminal vesicle sarcoma and an uncommon group of mixed epithelial-stromal tumors. The latter have been variably reported in the literature as cystadenoma, phyllodes tumor, and mullerian adenosarcoma-like tumor. We describe a 37-year-old man who presented with symptoms of bladder outlet obstruction and was found to have a pelvic mass. Resection of the mass yielded a biphasic tumor characterized by cystically dilated glandular spaces admixed with spindle-shaped stromal cells. There was no significant cytologic atypia or mitotic activity. The histologic features are most consistent with the reported cases of cystadenoma. The patient is alive, with no evidence of disease, 6 months after surgery. This case adds to the gradually growing body of literature on mixed epithelial-stromal tumors of the seminal vesicle.

Sarcomas and related proliferative lesions of specialized prostatic stroma: a clinicopathologic study of 22 cases

Sarcomas and related proliferative lesions of the specialized prostatic stroma have been the subject of case reports and, thus, have not been well characterized. We reviewed the clinicopathologic features of 22 cases and studied the immunohistochemical profile of 9. Patient age ranged from 25 to 86 years; mean age was 54 years, and peak incidence was in the 6th and 7th decades. The most common clinical presentation was urinary retention, then abnormal results of digital rectal examination, hematuria or hematospermia, and a palpable rectal mass. The cases were grouped into two categories: prostatic stromal proliferation of uncertain malignant potential (PSPUMP, 18 cases) and prostatic stromal sarcoma (PSS, 4 cases) based on the degree of stromal cellularity and the presence of mitotic figures, necrosis, and stromal overgrowth. Four histologic patterns of PSPUMP were identified: (1) hypercellular stroma with scattered cytologically atypical cells associated with benign glands, (2) hypercellular stroma with minimal cytological atypia associated with benign glands, (3) hypercellular stroma with or without cytologically atypical cells, associated with benign glands in a "leaflike" growth pattern that resembled phyllodes tumors of the mammary gland, and (4) hypercellular stroma without cytologically atypical stromal cells and without glands. Prostatic stromal sarcoma showed greater cellularity, mitoses, necrosis, and stromal overgrowth than PSPUMP and consisted either of stromal elements with benign glands in a pattern that resembled malignant phyllodes tumors of the mammary gland (3 cases) or of purely stromal elements (1 case). Positive immunohistochemical reactions were noted using vimentin in 9 of 9 cases, CD34 in 8 of 8, HHF-35 in 2 of 8, smooth muscle actin in 3 of 9, desmin in 4 of 8, S-100 protein in 0 of 9, estrogen receptor in 1 of 7, and progesterone receptor in 6 of 7. None of the cases classified as PSS were positive for HHF-35, smooth muscle actin, or desmin. Of the 13 patients classified as having PSPUMP who did not undergo definitive local therapy at the time of diagnosis, recurrent signs or symptoms were seen in six (46%), necessitating additional therapy. Distant metastases to lung and bone developed in one patient classified as having PSS. Clinical and pathologic findings in this patient suggested a progression from PSPUMP to PSS. We conclude that sarcomas and related proliferative lesions of the specialized prostatic stroma encompass a spectrum of histologic features and may be grouped into two clinicopathologic categories: PSPUMP and PSS. Based on their distinctive histologic appearance and immunohistochemical profile, PSPUMP and PSS can be differentiated from other mesenchymal lesions of the prostate.

Primary leiomyosarcoma of the seminal vesicle

A case of leiomyosarcoma of the seminal vesicle is described in a 68-year-old man. Digital rectal examination and pelvic computed tomography (CT) scan disclosed a large pelvic mass in the region of the prostate, whereas magnetic resonance imaging (MRI) suggested that the mass arose from the right seminal vesicle. Biopsy of the mass revealed a high-grade malignancy, thus a radical cystoprostatectomy was performed. Pathologic examination revealed a leiomyosarcoma arising from the right seminal vesicle. The patient is well and free of recurrent disease 13 months following surgery.

Malignant cystic epithelial-stromal tumor of the prostate

A huge cystic tumor in the pelvis of a 62-year old man, cytologically by fine needle aspiration biopsy, was composed of malignant spindle cells and transitional as well as glandular epithelial cells. Histochemical, immunostaining, and ultrastructural studies of the aspirated specimens and on the radically resected tumor indicated that the neoplastic cells are of prostatic fibroleiomyomatous stromal and epithelial origin. The lesion did not extend to the urothelium of the urinary bladder. This tumor resembles the rare cystadenoleiomyofibroma of the prostate, yet the cytologic abnormalities suggest a malignant potential. Long-term follow-up and recognition of additional cases are necessary to define the biologic behavior of this neoplasm.

Cystosarcoma phyllodes of the seminal vesicle

An unique case of high-grade phyllodes tumor (cystosarcoma phyllodes) arising in the seminal vesicle is reported. A 61-year-old man had symptoms of urinary obstruction, and ultrasonography and computed tomography showed a large mass posterior to the bladder. Using cystoprostatoseminovesiculectomy, a high-grade phyllodes tumor of the left seminal vesicle was found that did not involve the bladder or prostate. Histologically, the tumor consisted of benign irregular slit-like glands set in a mitotically active cellular sarcomatous stroma. The epithelium displayed intense cytoplasmic immunoreactivity with all keratin proteins (AE1/AE3, CAM 5.2, and high-molecular-weight keratin [clone 34 beta E12]). The stromal cells were strongly positive for vimentin, and approximately 30% were positive for muscle-specific actin and desmin. Four years after resection, a lung metastasis was removed, which was histologically and immunohistochemically identical to the seminal vesicle tumor. This case represents the malignant end of the range of phyllodes tumors (cystosarcoma phyllodes). Like similar tumors in the breast and prostate, phyllodes tumors of the seminal vesicle should be considered high-grade lesions (malignant) in which there is significant mitotic activity, stromal pleomorphism, and stromal overgrowth.

Cystadenoma of the seminal vesicle: case report and literature review

A benign fibroepithelial and cystic tumor of the seminal vesicle is described in a 63-year-old man. The symptoms, macroscopic appearance, microscopic characteristics, immunophenotype prognosis and complications of this rare benign tumor are discussed, and 9 previously reported cases are reviewed. Several terms have been used to describe benign fibroepithelial tumors of the seminal vesicle. We suggest that the term cystadenoma is the most appropriate.

Primary angiosarcoma of the seminal vesicle

We report on an unusual case of primary angiosarcoma of the seminal vesicle. Diagnosis was confirmed by light and electron microscopy, as well as specific immunohistochemical staining. This rare tumor is highly aggressive, and refractory to traditional surgical and adjuvant therapeutic modalities. Sarcomatous lesions of the seminal vesicle are reviewed.

Fibromuscular hyperplasia of the seminal vesicle

Examination of tissue removed during seminal vesiculectomy typically reveals few pathological abnormalities, although some tumors and cysts have been described. We report a case of seminal vesicle enlargement and pain due to fibromuscular hyperplasia. Complete pain relief ensued after seminal vesiculectomy.