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Wei Y, Wang H, Xie D, Lu J, Liang X, He W, Yang P, Wang J. Analysis of three primary prostatic sarcoma cases and literature review. Prostate 2024; 84:1218-1223. [PMID: 38982657 DOI: 10.1002/pros.24758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/10/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE The objective of this study is to evaluate the clinical presentations, diagnostic approaches, and treatment modalities for primary prostate sarcoma postradical prostatectomy, aiming to enhance its diagnosis and management. METHODS We retrospectively reviewed the clinical records of three male patients diagnosed with primary prostate sarcoma at Beijing Chaoyang Hospital, affiliated with Capital Medical University, from February 2014 to February 2024. All patients underwent transrectal prostate biopsies, which informed the decision to proceed with laparoscopic radical prostatectomies. After surgery, one patient received a combination of epirubicin and ifosfamide as immunotherapy, along with external beam radiotherapy. After comprehensive discussions regarding potential benefits and risks, the remaining two patients decided against undergoing radiotherapy and chemotherapy. RESULTS Based on the pathological examination results, two patients were diagnosed with stromal sarcoma and one with spindle cell sarcoma, all classified as high-grade sarcomas. Immunohistochemical analysis showed that all three cases were positive for VIMENTIN, but other results did not show significant specificity. During the follow-up period, one patient died within 12 months, and two patients were lost to follow-up after 6 months. However, there were no evident signs of recurrence observed during the follow-up period. CONCLUSIONS Primary prostate sarcoma is extremely rare and typically has a poor prognosis once diagnosed. Early diagnosis should be based on pathological and immunohistochemical testing results, followed by prompt surgical treatment and adjuvant radiotherapy and chemotherapy. Despite these measures, recurrence is common, underscoring the need for a detailed and appropriate treatment plan and systematic therapy for affected patients.
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Affiliation(s)
- Yirui Wei
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hao Wang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Dawei Xie
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jun Lu
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Liang
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Weifeng He
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Pushen Yang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jianwen Wang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Wang S, Huang S, Pan Y, Ma Y, Kang J, Liu L, Liu X. Leiomyoma of the prostate: A case report and systematic review. Front Surg 2022; 9:878411. [PMID: 36660196 PMCID: PMC9844217 DOI: 10.3389/fsurg.2022.878411] [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: 02/18/2022] [Accepted: 06/27/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose It is rare to find a large leiomyoma in the prostate, especially in that of a young man. This case report and systematic review provides additional information on the diagnosis, distinguishing features of imaging examinations, and treatment options. Patients and Methods We report on the case of a thirty-year-old man with a large leiomyoma of the prostate. MRI of the prostate revealed a round mass in the posterior lobe, 8.0 × 8.0 × 5.5 cm in size. With the assistance of laparoscopy, we resected the prostate mass completely and spared this organ. A systematic review was conducted utilizing the Preferred Reporting Items for Systematic Reviews (PRISMA) including English language published reports, from 1970 to December 2021. Results Urinary and erectile functioning was preserved postoperatively. After a year of follow-up, no evidence of recurrence emerged. A total of 21 studies were included for analysis. Conclusions A medical history of no, or few, lower urinary tract symptoms; the characteristics of a benign tumor in imaging examinations; and negative tumor markers should be included in any differential diagnosis of leiomyoma of the prostrate. A prostate biopsy should be performed before the preparative radical prostatectomy and choose nonsurgical treatment to confirm the diagnosis. Nowadays, minimally invasive surgery is the preferred effective option for this disease. It is a rare recurrence after its removal by means of surgery.
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Affiliation(s)
- Shangren Wang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Shiqiao Huang
- Department of Urology, Shanxian Central Hospital (Affiliated Huxi Hospital of Jining Medical University), Heze, China
| | - Yang Pan
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yong Ma
- Department of Urology, Shanxian Central Hospital (Affiliated Huxi Hospital of Jining Medical University), Heze, China
| | - Jiaqi Kang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China,Correspondence: Xiaoqiang Liu
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Marcal LP, Surabhi VR, Ramani NS, Katabathina VS, Paspulati RM, Prasad SR. Mesenchymal Neoplasms of the Prostate and Seminal Vesicles: Spectrum of Disease with Radiologic-Pathologic Correlation. Radiographics 2022; 42:417-432. [PMID: 35030067 DOI: 10.1148/rg.210084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There is a wide spectrum of benign and malignant mesenchymal neoplasms of the prostate, which account for less than 1% of all prostatic tumors. These include distinctive tumors that arise from the specialized prostatic stroma and site-agnostic neoplasms such as smooth muscle tumors, fibrous or myofibroblastic neoplasms, neurogenic tumors, vascular tumors, and a plethora of sarcomas. Select tumors show classic sites of origin within the prostate. While stromal tumors of uncertain malignant potential (STUMPs) commonly involve the peripheral zone at the prostate base, leiomyomas typically originate from the central prostate toward the apex. Some "prostatic" neoplasms such as gastrointestinal stromal tumors, solitary fibrous tumor (SFT), paragangliomas, and neurogenic tumors arise primarily from periprostatic soft tissues. Most mesenchymal tumors of the prostate and seminal vesicles manifest as large tumors that cause nonspecific symptoms; prostate-specific antigen level is not typically elevated. Diverse mesenchymal neoplasms demonstrate characteristic histopathologic and immunocytochemical features and variable cross-sectional imaging findings. While leiomyoma and SFT typically display low signal intensity on T2-weighted images, synovial sarcomas commonly show hemorrhage. Diagnosis is difficult because of the rarity and lack of awareness of the tumors and the significant overlap in histopathologic features. Select tumors show characteristic genetic abnormalities that allow the diagnosis to be established. For example, more than 90% of SFTs are characterized by a unique NAB2-STAT6 gene fusion, and more than 95% of synovial sarcomas are associated with a distinctive SYT-SSX chimeric transcript. Accurate diagnosis is imperative for optimal management owing to markedly different tumor biology as well as attendant therapeutic and prognostic implications. While STUMPs commonly recur, sarcomas typically charter an aggressive course with poor prognosis. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Leonardo P Marcal
- From the Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX 77030-4009 (L.P.M., V.R.S., S.R.P.); Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, Tex (N.S.R.); Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.); and Department of Radiology, Case Western Reserve University, Cleveland, Ohio (R.M.P.)
| | - Venkateswar R Surabhi
- From the Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX 77030-4009 (L.P.M., V.R.S., S.R.P.); Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, Tex (N.S.R.); Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.); and Department of Radiology, Case Western Reserve University, Cleveland, Ohio (R.M.P.)
| | - Nisha S Ramani
- From the Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX 77030-4009 (L.P.M., V.R.S., S.R.P.); Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, Tex (N.S.R.); Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.); and Department of Radiology, Case Western Reserve University, Cleveland, Ohio (R.M.P.)
| | - Venkata S Katabathina
- From the Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX 77030-4009 (L.P.M., V.R.S., S.R.P.); Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, Tex (N.S.R.); Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.); and Department of Radiology, Case Western Reserve University, Cleveland, Ohio (R.M.P.)
| | - Raj M Paspulati
- From the Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX 77030-4009 (L.P.M., V.R.S., S.R.P.); Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, Tex (N.S.R.); Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.); and Department of Radiology, Case Western Reserve University, Cleveland, Ohio (R.M.P.)
| | - Srinivasa R Prasad
- From the Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX 77030-4009 (L.P.M., V.R.S., S.R.P.); Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, Tex (N.S.R.); Department of Radiology, University of Texas Health Science Center, San Antonio, Tex (V.S.K.); and Department of Radiology, Case Western Reserve University, Cleveland, Ohio (R.M.P.)
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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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