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Luo H, Weng X, Zhong Z, Shan X, Lin W, Li S, Gu C. Spindle cell embryonal rhabdomyosarcoma of the prostate in an adult patient: a case report and review of the literature. J Int Med Res 2024; 52:3000605241234755. [PMID: 38501994 PMCID: PMC10953018 DOI: 10.1177/03000605241234755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/07/2024] [Indexed: 03/20/2024] Open
Abstract
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.
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Affiliation(s)
- Hanwen Luo
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Xiangtao Weng
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Zibin Zhong
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Xiongwei Shan
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Wenli Lin
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Siyi Li
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Chiming Gu
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
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2
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Perianal alveolar rhabdomyosarcoma with pulmonary lymphangitic sarcomatosis: Report of an autopsy case. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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3
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Sow O, Sarr A, Niang D, Mbow A, Sow Y, Khassim Ndoye A. Prostate rhabdomyosarcoma in a young adult: Case report and literature review. Urol Case Rep 2021; 39:101745. [PMID: 34195003 PMCID: PMC8225988 DOI: 10.1016/j.eucr.2021.101745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Primary rhabdomyosarcoma of the adult prostate is rare and associated with an aggressive clinical course. Combined modality therapy has resulted in marked improvement in survival rates and reduced surgical morbidity for children with these tumors. However, in adults the prognosis remains poor.We report on a case of prostate rhabdomyosarcoma in an adult approached with combined-modality treatment, with the administration of 9 courses of doxorubicin, vincristine and endoxan, and, subsequent radiotherapy to the prostaticbed. The patient remained free of progression of disease for about 1 year.
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Affiliation(s)
- Ousmane Sow
- Urology Andrology Department, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Alioune Sarr
- Urology Andrology Department, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Dibor Niang
- Department of Pathologists, Gaston Berger University, Saint-Louis, Senegal
| | - Aboubacry Mbow
- Urology Andrology Department, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Yaya Sow
- Urology Andrology Department, Aristide Le Dantec Hospital, Dakar, Senegal
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4
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Bostwick DG, Egevad L. Prostatic stromal proliferations: a review. Pathology 2020; 53:12-25. [PMID: 33190920 DOI: 10.1016/j.pathol.2020.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
Prostatic stromal proliferations account for the majority of benign tumour-like lesions in the prostate. The most common is nodular hyperplasia, seen in a majority of elderly men. Diagnostic difficulty is encountered with some variants, including stromal hyperplasia with atypia, characterised by degenerative changes of myofibroblasts. In contrast with benign stromal tumours, malignant stromal tumours of the prostate are rare, accounting for less than 0.1% of all prostatic malignancies. The most common are rhabdomyosarcoma (paediatric) and leiomyosarcoma (adults); others include phyllodes tumour and stromal sarcoma. Some authors lump malignant tumours with poor outcome (e.g., phyllodes tumour and stromal sarcoma) with benign stromal tumours (e.g., stromal hyperplasia with atypia, leiomyoma), considering them collectively to be of uncertain malignant potential, but this approach is discouraged. This review presents a contemporary approach to classification and diagnosis of prostatic stromal tumours.
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Affiliation(s)
- David G Bostwick
- Bostwick Laboratories, A Division of Poplar Healthcare, Orlando, FL, USA.
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
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5
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Olivas AD, Antic T. Rhabdomyosarcoma of the Adult Prostate: A Case Report With Complete Molecular Profile. Int J Surg Pathol 2019; 28:92-98. [DOI: 10.1177/1066896919867763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary rhabdomyosarcoma of the adult prostate is rare and associated with an aggressive clinical course. Given the limited number of cases reported about the prostate, little is known about the impact of molecular mutations on tumor biology and prognosis in adults. In this article, we present a case of primary embryonal rhabdomyosarcoma of the adult prostate with a complete molecular mutational profile of the tumor.
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6
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Tward JD, Poppe MM, Hitchcock YJ, O'Neil B, Albertson DJ, Shrieve DC. Demographics, stage distribution, and relative roles of surgery and radiotherapy on survival of persons with primary prostate sarcomas. Cancer Med 2018; 7:6030-6039. [PMID: 30453392 PMCID: PMC6308088 DOI: 10.1002/cam4.1872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 12/24/2022] Open
Abstract
Background Primary prostate sarcomas (PPS) are rare. Outcomes for this cancer have not been well characterized. Materials and Methods Subjects with a PPS diagnosed between 1973 and 2014 were identified in the SEER database. Subjects were stratified by disease stage and types of therapies received. Disease‐specific survival (DSS) and Overall survival (OS) was estimated by Kaplan‐Meier analysis and cohorts were compared with a univariate and multivariable Cox regression. Results The incidence of PPS among all prostate cancer diagnoses was 0.02%. Subjects younger than age 26 years at diagnosis represented 29% of cases, and 32% of primary prostate sarcomas were rhabdomyosarcoma histology. Rhabdomyosarcoma Histologies The median age at diagnosis was 9 years. Between age 0‐25 years rhabdomyosarcoma accounted for 96.4% of primary prostate sarcoma diagnoses, after age 25 rhabdomyosarcoma represented 15% of new diagnoses. The 10‐year DSS and OS for rhabdomyosarcoma was 47% and 44%. Non‐Rhabdomyosarcoma Histologies The median age at diagnosis was 71 years. The most common diagnoses were leiomyosarcoma (33%) and carcinosarcoma (28%). Localized, regional, or distant disease occurred in 40%, 34%, and 26% of cases. The 10‐year DSS and OS were 26% and 14%. In locally advanced cases, RT added to surgery trended toward improved DSS (P = 0.10). Conclusions Disease‐specific survival and OS for non‐rhabdomyosarcoma histologies appear inferior to those of rhabdomyosarcoma. The addition of RT to surgical resection may improve DSS in locally advanced non‐rhabdomyosarcoma. This is the largest report of the incidence, stage distribution, and survival for this extremely rare urologic malignancy providing valuable prognostic information.
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Affiliation(s)
- Jonathan D Tward
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Matthew M Poppe
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ying J Hitchcock
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Brock O'Neil
- Department of Urology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Daniel J Albertson
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Dennis C Shrieve
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah
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7
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Schildhaus HU, Lokka S, Fenner W, Küster J, Kühnle I, Heinmöller E. Spindle cell embryonal rhabdomyosarcoma of the prostate in an adult patient - case report and review of clinicopathological features. Diagn Pathol 2016; 11:56. [PMID: 27357857 PMCID: PMC4928285 DOI: 10.1186/s13000-016-0507-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/25/2016] [Indexed: 11/17/2022] Open
Abstract
Background Embryonal rhabdomyosarcoma of the prostate in an adult is a very rare event with only a few cases published. Diagnosis usually occurs with advanced disease frequently already with metastatic spread. In adults prognosis is very poor, therefore early diagnosis is crucial. To date, only three cases of spindle cell subtype of embryonal rhabdomyosarcoma of the prostate in an adult have been published. Case presentation We report an additional case of prostatic spindle cell embryonal rhabdomyosarcoma subtype in an adult. Conclusions We discuss relevant clinicopathological features of spindle cell embryonal rhabdomyosarcoma of the prostate in adult patients in the context of the literature.
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Affiliation(s)
| | - Suvi Lokka
- Institute of Pathology Nordhessen, Germaniastr. 7, 34119, Kassel, Germany
| | - Werner Fenner
- Deparment of Urology, Nephrologisches Zentrum, Vogelsang 105, 34346, Hann. Münden, Germany
| | - Jens Küster
- Deparment of Urology, Nephrologisches Zentrum, Vogelsang 105, 34346, Hann. Münden, Germany
| | - Ingrid Kühnle
- Department of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Ernst Heinmöller
- Institute of Pathology Nordhessen, Germaniastr. 7, 34119, Kassel, Germany
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8
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Prabhakaran P, Sanjayan R, Somanathan T, Narayanan G. Rhabdomyosarcoma of prostate presenting as bladder outlet obstruction in a young adult. Ecancermedicalscience 2013; 7:360. [PMID: 24143154 PMCID: PMC3796445 DOI: 10.3332/ecancer.2013.360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Indexed: 11/24/2022] Open
Abstract
A 19-year-old boy presented with bladder outlet obstruction and on evaluation was found to have prostatomegaly, which on biopsy was diagnostic of embryonal rhabdomyosarcoma (RMS). He had pulmonary metastasis and received chemotherapy with cyclophosphamide, doxorubicin, vincristine, actinomycin D, and radical radiotherapy. At one year, his prostatic tumour has resolved completely. Embryonal RMS of prostate occurs more commonly in infancy and childhood, so occurrence in young adults is rare, and a high index of suspicion is essential for early diagnosis and treatment.
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Affiliation(s)
- Pranab Prabhakaran
- Department of Medical Oncology, Regional Cancer Centre, Thiruvananthapuram, 695011 Kerala, India
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9
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Abstract
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.
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10
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Ciammella P, Galeandro M, D'Abbiero N, Palmieri T, Donini E, Iotti C. Prostate embryonal rhabdomyosarcoma in adults: Case report and review of literature. Rep Pract Oncol Radiother 2013; 18:310-5. [PMID: 24416569 DOI: 10.1016/j.rpor.2013.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 10/29/2012] [Accepted: 03/24/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Prostate embryonal rhabdomyosarcoma (ERMS) is a common tumour in infants and children, with a median occurrence age of 5 years, but it is rare in adults. It is characterized by a high degree of malignancy, both local rapid growth with formation of large pelvic masses, often leading to renal failure due to urethral obstruction, and systemic spread, commonly to the lungs, liver and bone. Several therapeutic approaches have been employed in the effort to treat prostate ERMS, but all of them have failed to gain a significant survival benefit in adult patients. CASE REPORT We report on a case of a stage IV prostate ERMS, approached with combined-modality treatment, with the administration of 5 courses of doxorubicin, ifosfamide and 2-mercaptoethane sulfonate sodium (mesna), and, subsequent radiotherapy to the prostatic bed (60 Gy/30 fxs). The patient remained free of progression of disease for about 1 year to finally experience a systemic relapse with multiple lung metastases and pleural effusion. The patient died for metastatic disease 27 months following the initial diagnosis. CONCLUSION While it remains questionable which therapeutic approach for prostate ERMS in adults is the most appropriate, our report demonstrates that a chemo-radiation combined treatment can control the prostate disease, reducing the symptoms and improving the quality of life of these patients, for the most part destined to die for systemic progression of disease.
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Affiliation(s)
- Patrizia Ciammella
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42121, Reggio Emilia, Italy
| | - Maria Galeandro
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42121, Reggio Emilia, Italy
| | - Nunziata D'Abbiero
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42121, Reggio Emilia, Italy
| | - Tamara Palmieri
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42121, Reggio Emilia, Italy
| | - Elisa Donini
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42121, Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42121, Reggio Emilia, Italy
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11
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Andreou A, Whitten C, MacVicar D, Fisher C, Sohaib A. Imaging appearance of sarcomas of the prostate. Cancer Imaging 2013; 13:228-37. [PMID: 23722584 PMCID: PMC3667567 DOI: 10.1102/1470-7330.2013.0024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Sarcomas of the prostate are rare tumours. Their clinicopathologic features are well described, however, the imaging features of these tumours have rarely been documented. The purpose of this article is to illustrate the imaging findings of prostate sarcomas, with an emphasis on their appearance on magnetic resonance imaging and to identify features that may help to differentiate them from the commoner prostate adenocarcinomas.
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Affiliation(s)
- Adrian Andreou
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, UK.
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12
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Latz S, Ellinger J, Goltz D, Marx C, Leuschner I, Müller SC, Fechner G. Spindle cell rhabdomyosarcoma of the prostate. Int J Urol 2013; 20:935-7. [PMID: 23320845 DOI: 10.1111/iju.12082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/16/2012] [Indexed: 12/01/2022]
Abstract
The spindle cell rhabdomyosarcoma is a rare variant of the embryonal rhabdomyosarcoma, mostly occurring in childhood. Only a few cases are described in adults. To date, no case of the spindle cell subtype of the prostatic embryonal rhabdomyosarcoma has been published. We report on a 23-year-old man, initially presenting with obstructive micturition problems, perineal pain and night sweat. After diagnosis by transrectal biopsy of the prostate, radiochemotherapy within the CWS 2002 P study was applied: nine cycles of vincristine, doxorubicin, actinomycin D, ifosfamide, and fractionated radiotherapy of the tumor and suspect lymph nodes (final dose 50.4 Gy). The tumor initially shrank, but an early local recurrence arose. Second-line chemotherapy was applied, followed by a salvage radical cytoprostatectomy. The patient died of disseminated disease 14 months after diagnosis.
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Affiliation(s)
- Stefan Latz
- Department of Urology, University of Bonn, Bonn, Germany
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13
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Yamazaki H, Ohyama T, Tsuboi T, Taoka Y, Kohguchi D, Iguchi H, Ao T. Prostatic stromal sarcoma with neuroectodermal differentiation. Diagn Pathol 2012; 7:173. [PMID: 23217062 PMCID: PMC3542249 DOI: 10.1186/1746-1596-7-173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/14/2012] [Indexed: 12/11/2022] Open
Abstract
Abstract Prostatic stromal sarcoma is a fairly rare tumor that constitutes approximately 0.1–0.2% of all prostatic cancers. Detailed characteristics of the tumor are still unclear due to its rarity. We describe a case of prostatic stromal sarcoma in a 63 year-old man who suffered from urinary obstructive symptoms. Palliative transuterine resection was performed and the preliminary histopathological diagnosis was neuroendocrine carcinoma. After chemotherapy, total pelvic exenteration was performed. Histopathologically, the tumor was composed of monotonously proliferating small to medium-sized round cells, which existed in compact islands with loose or dense fibrovascular networks. Immunohistochemically, the tumor cells were widely positive for vimentin, CD56, CD99 and focally positive for synaptophysin, CD10, progesterone receptor, desmin and CD34, but negative for EMA, cytokeratin, estrogen receptor, S-100 and myoglobin. Most of the previously reported tumors exhibited positive stainability for CD10 and progesterone receptor. In addition to these markers, expressions of CD56, CD99 and synaptophysin were characteristically detected in our case. To the best of our knowledge, we present the first case of prostatic stromal sarcoma with characteristic immunohistochemical staining properties. Although the biological characteristics of this rare tumor have not yet been elucidated, these findings suggest prostatic stromal sarcoma can potentially show neuroectodermal differentiation. Virtual slide The virtual slide(s) for this article can be found here:
http://www.diagnosticpathology.diagnomx.eu/vs/7291874028051262
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Affiliation(s)
- Hitoshi Yamazaki
- Department of Pathology, Medical center hospital, Kitasato Institute, Kitasato University, Saitama, Japan.
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14
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Abstract
Non-epithelial prostatic neoplasms are infrequent and cover a broad array of entities that include both benign and highly aggressive tumours. Because they are very infrequent, there is often limited understanding of them, and the recognition of these entities, when encountered, may pose a diagnostic challenge, owing to histological overlap between them or their rarity. Most lesions in this category are mesenchymal in origin, such as prostatic stromal tumours arising from specialized prostatic stroma, smooth muscle tumours, both benign and malignant, and solitary fibrous tumours. Less commonly occurring tumours include neural, germ cell and melanocytic tumours that may be derived from cells not normally present in the prostate. Some tumours have well-established extraprostatic counterparts and, when encountered, are more commonly extraprostatic/secondary in origin; these include gastrointestinal stromal tumours and most haematopoietic tumours. The majority of tumours are characterized by a spindle cell pattern with significant overlap in morphological features. In this setting, appropriate use of immunohistochemistry and molecular studies are often necessary for accurate diagnosis, prognosis, or prediction for therapy. This review addresses and updates the clinicopathological features of the entire spectrum of non-epithelial tumours with an approach to the histological diagnosis.
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Affiliation(s)
- Gladell P Paner
- Department of Pathology, University of Chicago, Chicago, IL, USA
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15
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Bisceglia M, Magro G, Carosi I, Cannazza V, Ben Dor D. Primary Embryonal Rhabdomyosarcoma of the Prostate in Adults. Int J Surg Pathol 2011; 19:831-7. [PMID: 21427103 DOI: 10.1177/1066896910395585] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study reports on a case of an adult patient with embryonal rhadomyosarcoma of the prostate and comprehensively reviews the world literature on this subject. The patient was a 49-year-old man with advanced stage disease, who initially underwent transurethral tumor resection and after diagnosis was given courses of chemotherapy prior to undergoing radical cystoprostatevesiculectomy. The tumor underwent histological examination supplemented by immunohistochemical analysis. After surgery, the patient experienced a huge pelvic recurrence and eventually died of disease 1 year after the original diagnosis. The world literature was reviewed based both on a PubMed/Medline search and the reference lists of all the available publications on this subject and only 24 cases of primary embryonal prostatic rhabdomyosarcoma have been found in the world literature in adult males (≥18 years). Embryonal rhadomyosarcoma of the prostate in adults is a very rare and aggressive disease. The long-term disease-specific survival rate is poor. Stage influences the outcome. Early diagnosis and complete surgical resection offer patients the best chance of improved survival.
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Affiliation(s)
- Michele Bisceglia
- IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, Italy
| | | | - Illuminato Carosi
- IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, Italy
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16
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Treetipsatit J, Kittikowit W, Zielenska M, Chaipipat M, Thorner PS, Shuangshoti S. Mixed embryonal/alveolar rhabdomyosarcoma of the prostate: report of a case with molecular genetic studies and literature review. Pediatr Dev Pathol 2009; 12:383-9. [PMID: 19175284 DOI: 10.2350/08-08-0518.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Alveolar rhabdomyosarcoma (RMS) is 1 of 2 main subtypes of RMS in the pediatric age group and tends to occur in the extremities. The urogenital tract is another common site for RMS, but this typically involves the embryonal subtype including sarcoma botryoides. We report a 28-year-old male with a prostatic tumor that was excised en bloc and showed a RMS with separate areas of embryonal and solid alveolar morphologies at the light microscopic level. Both areas showed diffuse nuclear expression for myogenin, and both areas expressed the PAX3-FKHR fusion gene, a genetic change associated with alveolar but not embryonal RMS. A review of the literature documented only 5 cases of RMS primary to the prostate showing alveolar or mixed histology. Ours is the 6th case and the 1st with molecular findings. Although the diagnostic category of mixed embryonal/alveolar RMS remains in use, the nature of this type of RMS is incompletely understood. In our case, although the morphology was mixed embryonal/alveolar, at the genetic level this tumor was alveolar in nature.
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Affiliation(s)
- Jitsupa Treetipsatit
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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17
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Adult prostate sarcoma: radiological–clinical correlation. Clin Radiol 2009; 64:171-7. [DOI: 10.1016/j.crad.2008.07.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 07/25/2008] [Accepted: 07/18/2008] [Indexed: 11/23/2022]
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18
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Abstract
Prostatic mesenchymal tumors encompass various benign and malignant neoplasms that may derived from the intrinsic prostatic stroma or from associated elements including muscle, connective tissue, blood vessels, and neural structures. The differential diagnosis of these tumors is broad and encompasses prostatic epithelial processes that demonstrate prominent spindle cell morphology, as well as mesenchymal tumors that secondarily involve the prostate. Careful morphologic examination, clinical history, and judicious use of a limited panel of immunohistochemical markers and molecular tests aid in the proper diagnosis of these lesions. This article provides a structured guide for the analysis and diagnosis of both benign and malignant prostatic mesenchymal lesions and highlights key features that distinguish these entities within the differential diagnosis of prostatic spindle cell lesions.
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Affiliation(s)
- Donna E Hansel
- Department of Anatomic Pathology, The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, The Cleveland Clinic, Cleveland, OH, USA; Glickman Urological and Kidney Institute, The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, The Cleveland Clinic, Cleveland, OH, USA; Taussig Cancer Institute, The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, The Cleveland Clinic, Cleveland, OH, USA.
| | - George J Netto
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Urology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Elizabeth A Montgomery
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jonathan I Epstein
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Urology, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD, USA
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19
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Abstract
Many significant benign and malignant nonepithelial tumors and stromal tumor-like lesions arise in the prostate gland. Although such lesions are rare, their recognition by the pathologist is essential because their treatment and prognosis are quite variable. In this review, lesions of the specialized prostatic stroma, that is, lesions that can be seen in the stroma of the prostate but not in that of other organs, except for the phyllodes type of lesions, are discussed. Benign and malignant lesions of the soft tissues that occur in the stroma of other organs and are seen with some frequency in the prostate are also discussed. Few of the rarer soft tissue lesions are mentioned. Lesions and tumors with melanocytic differentiation, hematopoietic derivation, and germ cell tumors are described. It is hoped that this review will serve as a useful reference when encountering some of these lesions, all of which are referenced to their original and subsequent reports. Some non-English language references are also cited to reflect the international recognition of these lesions or to give credit to the author who first described the entity.
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Affiliation(s)
- A Shabaik
- Department of Pathology, University of California, School of Medicine, UCSD Medical Center, San Diego, CA 92103-8720, USA
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Gupta P, Roy S, Singh OP, Rawat SK, Arora D. Primary Sarcoma of the Prostate and Thrombocythemia in Adult; A First Case Report in English Literature. APOLLO MEDICINE 2008. [DOI: 10.1016/s0976-0016(11)60494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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21
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Almeida FAGD, Macêdo Filho CLD, Melo ELA, Cerri LMDO, Cerri GG. Rabdomiossarcoma prostático em adulto: relato de caso. Radiol Bras 2007. [DOI: 10.1590/s0100-39842007000600013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O rabdomiossarcoma prostático é um tumor agressivo, encontrado predominantemente na infância, sendo bastante raro na vida adulta. Apresentamos o caso de um paciente de 27 anos de idade que tinha lesão extensa, com invasão dos planos periprostáticos e metástases a distância no momento do diagnóstico. Estudamos os achados aos exames de ultra-som, tomografia computadorizada, ressonância magnética e tomografia por emissão de pósitrons/tomografia computadorizada, correlacionando-os com os casos já descritos na literatura.
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22
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Abstract
Prostatic spindle cell lesions are diagnostically challenging and encompass a broad array of benign and malignant processes. A subset of these lesions arises only within the prostate and generally represents entities that originate from the prostate epithelium or stroma, such as sclerosing adenosis, sarcomatoid carcinoma, stromal tumors of uncertain malignant potential (STUMP), and stromal sarcoma. Another subset of spindle cell tumors that involve the prostate are also found at other sites and include solitary fibrous tumor, leiomyosarcoma, and neural lesions among others. Finally, tumors may secondarily involve the prostate yet present as primary prostatic processes, as is evident with several cases of gastrointestinal stromal tumors (GIST). The utility of ancillary studies, including immunohistochemistry, is often limited and the main criteria for diagnosis are the morphologic findings by routine H&E stain. This review addresses the various entities that may present as spindle cell tumors within the adult prostate and discusses the functional aspects of the differential diagnosis of these lesions.
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Affiliation(s)
- Donna E Hansel
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA
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23
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Arrús J, Puigvert A, Camps N, Caffaratti J, Pomerol J. Disfunción eréctil y rabdomiosarcoma de próstata: a propósito de un caso. Rev Int Androl 2005. [DOI: 10.1016/s1698-031x(05)74687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Nabi G, Dinda AK, Dogra PN. Primary embryonal rhabdomyosarcoma of prostate in adults: diagnosis and management. Int Urol Nephrol 2003; 34:531-4. [PMID: 14577499 DOI: 10.1023/a:1025638711476] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Embryonal rhabdomyosarcoma of the prostate is a common tumour in infants and children. It is rarely seen in adults. The combined modality has improved outcome in children, where as in adults prognosis is poor. The lack of awareness of this entity in adults, delay in diagnosis and a more aggressive behavior of this malignancy are some of the reasons. We report two cases of embroyonal rhabdomyosarcoma of prostate in adults along with review of literature with an aim to define natural history and formulate treatment policy.
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Affiliation(s)
- G Nabi
- Department of Urology, All India Institute of Medical Sciences, New Delhi-29, India.
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25
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Ifosfamide, doxorubicin and dacarbazine chemotherapy, and adjunctive laparoscopic cystoprostatectomy and external beam radiotherapy for prostatic embryonal rhabdomyosarcoma. J Urol 2002; 168:2545. [PMID: 12441967 DOI: 10.1016/s0022-5347(05)64195-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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CHALCHAL H, TAI THP, TSE E, ALPORT EC, SALIM M. Ifosfamide, Doxorubicin and Dacarbazine Chemotherapy, and Adjunctive Laparoscopic Cystoprostatectomy and External Beam Radiotherapy for Prostatic Embryonal Rhabdomyosarcoma. J Urol 2002. [DOI: 10.1097/00005392-200212000-00053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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De Raeve H, Jeuris W, Wyndaele JJ, Van Marck E. Cystosarcoma phyllodes of the prostate with rhabdomyoblastic differentiation. Pathol Res Pract 2002; 197:657-62. [PMID: 11700886 DOI: 10.1078/0344-0338-00142] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- H De Raeve
- Department of Surgical Pathology, University Hospital Antwerp, Edegem, Belgium
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28
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Montironi R. Spectrum of prostatic non-epithelial tumour-like conditions and tumours. Pathol Res Pract 2002; 197:653-5. [PMID: 11700885 DOI: 10.1078/0344-0338-00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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29
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Esnaola NF, Rubin BP, Baldini EH, Vasudevan N, Demetri GD, Fletcher CD, Singer S. Response to chemotherapy and predictors of survival in adult rhabdomyosarcoma. Ann Surg 2001; 234:215-23. [PMID: 11505068 PMCID: PMC1422009 DOI: 10.1097/00000658-200108000-00012] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess outcome and identify predictors of survival of adults with rhabdomyosarcoma. SUMMARY BACKGROUND DATA The literature on adult rhabdomyosarcoma is limited. Few studies have identified predictors of long-term survival in this patient population. METHODS Thirty-nine adults with rhabdomyosarcoma were treated between 1973 and 1996 and prospectively followed. Outcomes were assessed with respect to patient and tumor characteristics, local treatment, and response to chemotherapy. RESULTS Twenty-six patients had localized/locoregional disease and 13 patients had metastatic disease at presentation. Twenty-one patients underwent attempted curative resection, 27 received radiotherapy, and 37 received chemotherapy. Median follow-up for surviving patients was 152 months. The overall 5- and 10-year survival rates were 31% and 27%, respectively. Five-year survival rates for patients with tumors less than 5 cm, 5 to 10 cm, and more than 10 cm were 60%, 14%, and 0%, respectively. Patients with localized/locoregional disease at presentation had a 44% 5-year survival rate; there were no 5-year survivors among patients with metastatic disease. Patients who had a complete response to chemotherapy had a 5-year survival rate of 57%, compared with a rate of only 7% for poor responders. Metastatic disease at presentation and poor response to chemotherapy were independent predictors of death on multivariate analysis. CONCLUSIONS Age, location, nodal status, and histologic subtype do not appear be associated with survival in adults with rhabdomyosarcoma treated with multimodal therapy. Metastatic disease at presentation and poor response to chemotherapy are strongly associated with poor prognosis. Future systemic therapies should be targeted to patients with localized/locoregional disease and partial responders to conventional chemotherapy.
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Affiliation(s)
- N F Esnaola
- Division of Surgical Oncology, Department of Surgery, Radiation Oncology and Pathology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA
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30
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Middel P, Gunawan B, Gross AJ, Radzun HJ, Füzesi L. Chromosome abnormalities in a primary adult embryonal rhabdomyosarcoma of the prostate. Histopathology 2000; 37:378-80. [PMID: 11184186 DOI: 10.1046/j.1365-2559.2000.00997-3.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
MESH Headings
- Chromosome Aberrations
- Chromosome Deletion
- Chromosome Disorders
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 19/genetics
- Chromosomes, Human, Pair 2/genetics
- Chromosomes, Human, Pair 5/genetics
- Chromosomes, Human, Pair 6/genetics
- Humans
- Karyotyping
- Male
- Middle Aged
- Prostatic Neoplasms/genetics
- Prostatic Neoplasms/pathology
- Rhabdomyosarcoma, Embryonal/genetics
- Rhabdomyosarcoma, Embryonal/pathology
- Translocation, Genetic
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31
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Froehner M, Lossnitzer A, Manseck A, Koch R, Noack B, Wirth MP. Favorable long-term outcome in adult genitourinary low-grade sarcoma. Urology 2000; 56:373-7. [PMID: 10962297 DOI: 10.1016/s0090-4295(00)00704-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report our experience treating sarcomas in 20 consecutive patients. METHODS Pretreatment and follow-up data were obtained from 20 adult patients consecutively treated between 1992 and 1998 for primary or locally recurrent genitourinary sarcoma. RESULTS Eight patients (40%) were classified as having high-grade and 12 (60%) low-grade disease. Except for 3 patients, the primary treatment was surgery alone. The median follow-up was 52 months. The actuarial disease-specific 5-year survival rate was 84% in all patients and was 100% for patients with Memorial Sloan Kettering Cancer Center (MSKCC) Stages 1-2 and 54% in MSKCC Stages 3-4. The disease-specific survival was significantly better in low-grade tumors (log-rank test, P = 0.0063) and inguinal-scrotal tumors (P = 0.019), tumors 5 cm or less (P = 0.039), and MSKCC Stages 1-2 tumors (P = 0.0035). CONCLUSIONS The results of this study with a high proportion of low-grade, low-stage, and inguinal-scrotal sarcomas demonstrate the favorable prognosis of these subgroups.
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Affiliation(s)
- M Froehner
- Department of Urology, University Clinics Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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32
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SUBSEQUENT URETHRAL RELAPSES WITH EXTENSION INTO THE CORPORA CAVERNOSA OF EMBRYONAL RHABDOMYOSARCOMA OF THE PROSTATE. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68845-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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33
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Gaudin PB, Rosai J, Epstein JI. Sarcomas and related proliferative lesions of specialized prostatic stroma: a clinicopathologic study of 22 cases. Am J Surg Pathol 1998; 22:148-62. [PMID: 9500215 DOI: 10.1097/00000478-199802000-00002] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- P B Gaudin
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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