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Huong NL, Hang DT, Duong VN, Anh NTH, Hung ND, Cong BT, Thong PM, Duc NM. Magnetic resonance imaging presentation of prostatic stromal sarcoma. Radiol Case Rep 2024; 19:4457-4463. [PMID: 39185438 PMCID: PMC11342799 DOI: 10.1016/j.radcr.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 08/27/2024] Open
Abstract
Prostatic stromal sarcoma (PSS) is a rare malignant tumor that often occurs in young people. Despite the fact that their clinical pathological characteristics are well known, our understanding of the imaging characteristics still seems to be limited. In our search of the literature, PSS articles are mainly present as case reports. In this case series of PSS, we aimed to thoroughly describe the magnetic resonance imaging (MRI) features, histopathological findings, and distinguishing hallmarks from prostate cancer (PCA).
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Affiliation(s)
| | - Dinh Thu Hang
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
| | - Vu Ngoc Duong
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | | | - Nguyen Duy Hung
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Bui Tien Cong
- Department of Nuclear Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Pham Minh Thong
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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2
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Kawaguchi T, Tanaka T, Ogasawara M, Ikuya I. Long-term disease control after upfront chemotherapy and surgery in a patient with primary prostate leiomyosarcoma. IJU Case Rep 2022; 5:88-91. [PMID: 35252786 PMCID: PMC8888012 DOI: 10.1002/iju5.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Prostate leiomyosarcoma is a rare, aggressive neoplasm. CASE PRESENTATION A 52-year-old man presented with worsening frequent micturition and painful urination. Rectal examination revealed a significantly enlarged prostate. Magnetic resonance imaging showed a large prostate tumor with urinary bladder and bilateral seminal vesicle invasion. A prostate biopsy revealed diffuse proliferation of pleomorphic atypical cells. Immunohistochemistry confirmed the diagnosis of prostrate leiomyosarcoma. The patient received three cycles of the mesna, doxorubicin, ifosfamide, and dacarbazine regime (mesna 6000 mg/m2, doxorubicin 60 mg/m2, ifosfamide 7500 mg/m2, and dacarbazine 900 mg/m2) at 4-week intervals. The tumor shrank by 28% and exhibited necrotic changes. He underwent total pelvic exenteration with en bloc resection of the prostate, bladder, rectum, and anus. Pathological surgical margin was negative. The patient is alive with no disease at 5 years postoperatively. CONCLUSION Neoadjuvant chemotherapy and surgical resection are essential to achieve a long-term survival of patients with localized prostate leiomyosarcoma.
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Affiliation(s)
- Toshiaki Kawaguchi
- Department of UrologyAomori Prefectural Central HospitalAomori‐shiAomoriJapan
| | - Toshikazu Tanaka
- Department of UrologyAomori Prefectural Central HospitalAomori‐shiAomoriJapan
| | - Masaru Ogasawara
- Department of UrologyAomori Prefectural Central HospitalAomori‐shiAomoriJapan
| | - Iwabuchi Ikuya
- Department of UrologyAomori Prefectural Central HospitalAomori‐shiAomoriJapan
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3
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Xu W, Dong H, Ru G, Zhao M. ARID1A deficient undifferentiated spindle cell and rhabdoid sarcoma of the prostate: report of a unique case with emphasis on diagnostic implications. Diagn Pathol 2022; 17:22. [PMID: 35125107 PMCID: PMC8818209 DOI: 10.1186/s13000-022-01198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background SWItch Sucrose Non-Fermentable (SWI/SNF) chromatin-remodeling complex functions collectively as a tumor suppressor and the inactivation of any of its constituent components is frequently associated with tumor initiation and/or progression. Most SWI/SNF deficient tumors share common rhabdoid morphology. ARID1A is the most frequently dysregulated SWI/SNF subunit in human cancer and inactivation of ARID1A is frequent across carcinomatous types while very rarely drives the tumorigenesis of sarcomas. Herein, we report a rare case of primary prostatic undifferentiated spindle cell sarcoma with focal rhabdoid morphology, harboring biallelic inactivation of ARID1A detected by next-generation sequencing with complete loss of ARID1A expression by immunohistochemistry. Case presentation The patient is a 58-year-old man who presented with dysuria and obstructive voiding symptoms for 3 month and was found to have a large, ill-defined, prostatic mass lesion with circumferential extension into the rectal wall on imaging studies. A needle biopsy showed a spindle cell undifferentiated sarcoma of the prostate and the patient was treated by chemotherapy of combined etoposide and cisplatin for 2 months. A subsequent imaging study showed that the tumor was significantly enlarged, and the patient underwent laparoscopically radical prostatectomy. Gross examination showed a disrupted, 10 × 7 × 5 cm, solid and cystic mass involving almost the entire prostate and sparing the seminal vesicle glands. Histologic examination showed that tumor was composed mainly of mildly atypical, oval to spindle-shaped cells, arranged in sheets and fascicles or herringbone-like patterns within a small amount of edematous to myxoid, vascularized stroma. Notably, groups of discohesive rhabdoid tumor cells with eccentric nuclei, prominent nucleoli, and abundant globular cytoplasm were observed. There were prominent mitotic figures, multifocal geographic necroses, and foci of lymphovascular invasion. Immunohistochemistry showed that the tumor cells were diffusely positive for TLE-1 and vimentin and focally positive for epithelial membrane antigen, AE1/3, Cam5.2, SATB2, and CD34 (all in less than 10% tumor cells). Next-generation sequencing showed biallelic inactivation mutation of ARID1A; the predicted inactivating effect of ARID1A deletion was confirmed by immunohistochemical staining. After the surgery, the patient received an alternative combined chemotherapy of doxorubicin and ifosfamide for 5 months. The patient died 9 months after initial presentation due to extensive abdominal metastases. Conclusions We report an ARID1A deficient undifferentiated spindle cell and rhabdoid sarcoma of the prostate, adding to the growing spectrum of SWI/SNF driven undifferentiated sarcoma. Rhabdoid cells can be a helpful morphological clue for promoting molecular and immunohistochemical analyses for deficiency of SWI/SNF subunits, in the diagnostic workup of undifferentiated neoplasms featuring epithelioid or rhabdoid morphology. Supplementary Information The online version contains supplementary material available at 10.1186/s13000-022-01198-4.
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Wang L, Wang L, Hou D, Dong S, Wang A, Wang H. Benefits from standalone durvalumab treatment in an elderly patient with advanced prostatic sarcoma: a case report. Transl Androl Urol 2022; 10:4298-4303. [PMID: 34984194 PMCID: PMC8661254 DOI: 10.21037/tau-21-125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 11/17/2021] [Indexed: 12/05/2022] Open
Abstract
There is a lacking of effective therapeutic strategies in the treatment of advanced prostatic sarcoma with high-frequency microsatellite instability (MSI-H) or mismatch repair deficient (dMMR). In this study, we present the first described a case of advanced MSI-H and dMMR prostatic sarcoma in elderly patients with multiple comorbidities, who received an anti-PD-L1 monoclonal antibody (durvalumab) as the first-line treatment and achieved partial remission (PR) without visible adverse events. A 91-year-old male patient presented with frequent urination and defecation difficulty for over three months, aggravating for ten days. Digital rectal examination showed the prostate gland was III° enlargement and tough with a smooth surface. The MRI showed occupying lesions in the prostate without distant metastasis. Then, the prostate biopsy showed poorly differentiated small round cell malignant tumor and considered prostatic sarcoma. Immunohistochemistry showed MSI-H and dMMR prostatic sarcoma. Durvalumab alone was applied at a cycle of every 21 days (500 mg/day) for 18 months and achieved PR two months since the treatment. During the treatment, we didn’t observe rash, immune-related pneumonia, hepatitis, and other adverse events. Also, no recurrence or metastasis was observed until now. Durvalumab is effective and safe in the treatment of advanced MSI-H or dMMR prostatic sarcoma in an elderly patient. It is promising to be an available choice for advanced prostate sarcoma, which is unsuitable for surgery, conventional chemotherapy, and radiotherapy.
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Affiliation(s)
- Lili Wang
- Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, China
| | - Lei Wang
- Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, China
| | - Dingkun Hou
- Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, China
| | - Shiqiang Dong
- Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, China
| | - Aixiang Wang
- Department of Pathology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, China
| | - Haitao Wang
- Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, China
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Patel SR, Hensel CP, He J, Alcalá NE, Kearns JT, Gaston KE, Clark PE, Riggs SB. Epidemiology and survival outcome of adult kidney, bladder, and prostate rhabdomyosarcoma: A SEER database analysis. Rare Tumors 2020; 12:2036361320977401. [PMID: 33329884 PMCID: PMC7720312 DOI: 10.1177/2036361320977401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/09/2020] [Indexed: 12/14/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is rare in adulthood, accounting for 2%-5% of adult soft tissue tumors, and less than 20% occur in genitourinary organs. Given its rarity, survival data on adult kidney, bladder, and prostate RMSs is limited. In this population-based analysis, we performed an analysis of all adult RMS cases reported in Surveillance, Epidemiology, and End Results (SEER) database to understand prognostic factors among kidney, bladder, and prostate RMS. A query of the SEER database was performed from 1973 to 2016 for patients >18 of age with RMS. The final cohort consisted of 14 kidney, 35 bladder, and 21 prostate RMS cases in the adult population. Demographic, treatment, and survival data were obtained. Analysis was performed using Fisher's exact test, survival analysis, and model. The median (range) age of diagnosis for adult bladder RMS was 65 years old (19-84) compared to 52.5 (28-68) and 42 (19-87) for kidney and prostate (p = 0.007). About 78.6% of patients underwent surgical intervention. Five-year overall survival (OS) for adult kidney, bladder, and prostate RMS are 17.1% (2.9-41.6%), 22.2% (9.4-38.4%), and 33.0 (12.8-55.0%), respectively. OS was not statistically associated with primary site (p = 0.209). On multivariable analysis, compared to adult bladder RMS, kidney RMS had a higher incidence of mortality (HR: 2.16, 95% CI 1.03-4.53, p = 0.041). Incidence of mortality from prostate RMS was not significantly different from bladder RMS (HR: 0.70, 95% CI 0.30-1.65, p = 0.411). Extent of disease (HR: 5.17, 95% CI 2.09-12.79, p < 0.001) and older age (HR 1.03, 95% CI 1.01-1.04, p = 0.002) were adverse prognostic factors for OS. Overall survival at 5 years for adult kidney, bladder, and prostate RMS is poor. Localized disease and younger age are prognostic factors for improved outcomes in adult RMS. Hence, early diagnosis and intervention appear paramount to improved survival for this rare malignancy in adulthood.
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Affiliation(s)
- Sagar R Patel
- Department of Urology, Atrium Health, Charlotte, NC, USA.,University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Caitlin P Hensel
- Department of Biostatistics, Levine Cancer Institute, Charlotte, NC, USA
| | - Jiaxian He
- Department of Biostatistics, Levine Cancer Institute, Charlotte, NC, USA
| | - Nicolas E Alcalá
- Department of Urology, Atrium Health, Charlotte, NC, USA.,University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - James T Kearns
- Department of Urology, Atrium Health, Charlotte, NC, USA
| | - Kris E Gaston
- Department of Urology, Atrium Health, Charlotte, NC, USA
| | - Peter E Clark
- Department of Urology, Atrium Health, Charlotte, NC, USA
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Kim J, Yassein A, Blankstein U, Bonert M, Kapoor A. Images - Rare diagnosis of high-grade, undifferentiated pelvic sarcoma for urinary dysfunction in a young man. Can Urol Assoc J 2020; 15:E192-E194. [PMID: 32807281 DOI: 10.5489/cuaj.6703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jaehoon Kim
- McMaster Institute of Urology, Hamilton, ON, Canada
| | | | | | - Michael Bonert
- Department of Pathology and Molecular Medicine, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Anil Kapoor
- McMaster Institute of Urology, Hamilton, ON, Canada
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7
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Ding B, Zhang Y, Hu W, Hu D, Liu J, Zhao S, Wang F, Xue L, Xu Z, Chen L. Adult primary prostate sarcoma: A multi-center cohort study and comparison between Chinese and American cases. Asian J Surg 2020; 44:247-253. [PMID: 32636119 DOI: 10.1016/j.asjsur.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES To assess the effects of clinical factors and treatments on the overall survival (OS) of patients with prostate sarcomas. METHODS We reported 41 cases diagnosed with prostate sarcomas from eight hospitals in China and retrospectively analyzed the prognostic factors by combining our data with cases from five previously published cohorts, including one extra Chinese cohort and four cohorts from US cohorts. Additionally, we investigated the differences in treatment regimens between China (n = 66) and the USA (n = 74). RESULTS The median survival time of the 41 cases was 18.6 months (95% confidence interval [CI]: 13.9-23.2). The status of negative distant metastasis (P = 0.004) and radical tumor resection with negative margin (P = 0.001) were significantly associated with better overall survival, whereas age, tumor size, duration of initial symptoms, and chemo/radiotherapy were not significantly related to OS. The survival time was longer in patients with rhabdomyosarcoma than in those with leiomyosarcoma (P = 0.049). Combined analysis of the current and 5 prior cohorts showed that more patients in the US cohorts underwent radical surgery (P = 0.005), and the overall survival was better among those with radical cystoprostatectomy compared to those with radical prostatectomy alone (P = 0.008). CONCLUSION Radical resection to achieve a negative margin contributes to better survival for patients with prostate sarcoma.
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Affiliation(s)
- Beichen Ding
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430030, China; Department of Urology Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 15001, China
| | - Yucong Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430030, China
| | - Wei Hu
- Department of Urology, Hubei General Hospital, Wuhan University, Wuhan, 430060, China
| | - Dongliang Hu
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China
| | - Jianjun Liu
- Department of Urology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524000, China
| | - Shanchao Zhao
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Fei Wang
- Department of Urology, Hainan General Hospital, Haikou, 570311, China
| | - Li Xue
- Department of Urology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Zhanping Xu
- Department of Urology, Guangdong General Hospital, Guangzhou, 510080, China
| | - Liang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430030, China.
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8
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Iwahashi Y, Matsumura N, Kusumoto H, Ozaki T, Higuchi M, Kohjimoto Y, Hara I. Undifferentiated pleomorphic sarcoma of the prostate in a young man. IJU Case Rep 2020; 3:145-148. [PMID: 33392475 PMCID: PMC7770594 DOI: 10.1002/iju5.12174] [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: 02/26/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Prostate sarcoma is an extremely rare disease with a poor prognosis. Undifferentiated pleomorphic sarcoma has never been described in the prostate.Case presentation: A 27-year-old man complained of frequent urination and dysuria for several years. Various examinations were suggestive of prostate sarcoma. The pathological diagnosis was confirmed as prostate sarcoma via ultrasound-guided transrectal needle biopsy. Because the location of the tumor in the prostate was confirmed by magnetic resonance imaging, we performed robot-assisted radical prostatectomy. The final pathological diagnosis was undifferentiated pleomorphic sarcoma. Local recurrence occurred at the front of the rectum 2 months after surgery. Although chemotherapy and radiotherapy were initially effective, he died 18 months after surgery. CONCLUSION Undifferentiated pleomorphic sarcoma of the prostate is believed to have a poor prognosis. When selecting the surgical procedure, functionality should be considered for individual cases with complete resection.
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Affiliation(s)
- Yuya Iwahashi
- Department ofUrologyKinan HospitalTanabeWakayamaJapan
| | | | | | - Takashi Ozaki
- Department ofPathologyKinan HospitalTanabeWakayamaJapan
| | - Masatoshi Higuchi
- Department of UrologyWakayama Medical UniversityWakayamaWakayamaJapan
| | - Yasuo Kohjimoto
- Department of UrologyWakayama Medical UniversityWakayamaWakayamaJapan
| | - Isao Hara
- Department of UrologyWakayama Medical UniversityWakayamaWakayamaJapan
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9
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Wang MQ, Zhang JL, Yuan K, Yuan B, Duan F, Yan JY, Wang Y, Fu JX. Large inoperable leiomyosarcoma of the prostate: treated by transcatheter arterial chemoembolization with drug-eluting microspheres. Ther Adv Med Oncol 2020; 12:1758835920917573. [PMID: 32489428 PMCID: PMC7238308 DOI: 10.1177/1758835920917573] [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: 10/29/2019] [Accepted: 03/13/2020] [Indexed: 12/17/2022] Open
Abstract
Background Prostatic leiomyosarcoma (LMS) has a poor prognosis with a median overall survival (OS) of 15-18 months. For patients with metastatic disease, radical surgical resection, with or without adjuvant systemic chemotherapy and radiation therapy, unfortunately provides limited therapeutic benefit. Novel approaches for this lethal disease are urgently needed. Objectives To evaluate the feasibility and efficacy of transarterial chemoembolization (TACE) with doxorubicin-eluting HepaSpheres (HS) for inoperable LMS of the prostate. Methods This case series included 12 patients (median age 57 years, range 32-74) with inoperable LMS of the prostate who were treated with TACE using doxorubicin-eluting HS. All patients were pathologically proved by fine-needle biopsy. Symptomatic relief, complications, OS, and local disease control based on modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria were evaluated. Results Symptomatic relief, including control of the gross hematuria, removal of indwelling catheters, improvement of constipation and perineal pain, were obtained in 100%, 75%, 100%, and 86%, respectively after TACE, without any major complications. At the last follow-up after TACE, the percentage of the tumor necrosis and volume reduction were present with a median value of 90% and 84%, respectively. TACE after two to four sessions allowed subsequent surgical resection in five (41.7%) patients. The median follow-up time was 29 months; the survival rate at 1, 2, and 3 years was 91.7%, 83.3%, and 41.7%, respectively, and the median OS was 29 months (range 9-49 months). Conclusions TACE of inoperable LMS of the prostate appears to be safe and effective in providing tumor necrosis, shrinkage, and symptom relief; that could improve the quality of life and the survival rate of these patients.
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Affiliation(s)
- Mao Qiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing 100853, P.R. China
| | - Jin Long Zhang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Kai Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Bing Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Feng Duan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu Yan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Yan Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jin Xin Fu
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
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Difficulty in distinguishing radiation-induced prostate sarcoma from radiation mucositis in a patient with persistent urinary retention and hematuria after prostate cancer radiotherapy. Int Cancer Conf J 2020; 9:133-136. [PMID: 32582517 DOI: 10.1007/s13691-020-00407-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/09/2020] [Indexed: 10/24/2022] Open
Abstract
Urinary retention and hematuria owing to radiation-induced mucositis are occasional late adverse events in patients with prostate cancer. Moreover, radiation-induced secondary malignancies are late adverse events, although they are extremely rare. Herein, we describe a case of radiation-induced secondary malignancy of the prostate that was initially difficult to distinguish from radiation mucositis. A 74-year-old man with prostate cancer underwent brachytherapy and external beam radiotherapy 9 years ago. Twenty-eight months after irradiation, he presented with urinary retention and hematuria owing to radiation mucositis and underwent transurethral resection of the prostate. At 89 months after irradiation, the patient again showed urinary retention and hematuria. The cause of urinary retention and hematuria could not be identified on cystoscopy. Despite receiving medications, the patient's symptoms did not improve. Therefore, transurethral fulguration was performed, and prostate biopsy revealed spindle cell sarcoma. A diagnosis of radiation-induced undifferentiated pleomorphic/spindle cell sarcoma was made, and the patient underwent total cystectomy and construction of the ileal conduit. Two weeks after the surgery, computed tomography revealed peritoneal dissemination. The patient died 5 weeks after the surgery. The case findings indicate that clinicians should consider the possibility of radiation-induced secondary malignancy; moreover, thorough pathological examination of the prostate with CT and MRI is important to distinguish RISM from radiation mucositis even if no tumors are found on cystoscopy.
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11
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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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12
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Alves LJ, Gameiro CD, Lopes SP, Ascensão JDB, Sousa RC. Prostate Leiomyosarcoma: A Rare Misleading Tumor. Urology 2019; 130:13-16. [DOI: 10.1016/j.urology.2019.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 03/30/2019] [Accepted: 04/09/2019] [Indexed: 12/01/2022]
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13
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Ding B, Song W, Du F, Chen L, Song X. Complete resection of adult prostatic rhabdomyosarcoma with 3D video and printing model: A case report and literature review. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:177-183. [PMID: 30562915 DOI: 10.3233/xst-180458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prostatic rhabdomyosarcoma (RMS) is a subtype of prostate sarcoma which is rarely reported in adults and usually huge in size. Although there is no consensus on the standard therapy to prostatic RMS, complete resection with negative margin is identified as the best way for maximum survival time. However, to remove a much enlarged prostate completely from a RMS patient is still a very difficult task for a skilled urologist so far. As three-dimension (3D) technology becomes more widely used in medicine, surgeons have the opportunity to challenge previously impossible surgery. In this paper, we reported a 36-year-old male patient with a 9.6*5.3*7.6 cm prostatic RMS. With the aid of 3D reconstructed video and printing model, the giant tumor was entirely removed without surgery complications and adjacent organs injury. The patient was alive and had no recurrence after 18 months from surgery. This case revealed that 3D reconstruction technology could help in the preoperative assessment and gave benefits to both patients and surgeons.
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Affiliation(s)
- Beichen Ding
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Feilong Du
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaodong Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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14
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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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15
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Kim H, Kim DY, Seol YM, Ku JY, Choi KU, Choi YJ. Primary malignant peripheral nerve sheath tumor of prostate in a young adult: A case report. Medicine (Baltimore) 2018; 97:e12040. [PMID: 30278486 PMCID: PMC6181477 DOI: 10.1097/md.0000000000012040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Prostate sarcoma has been reported to represent 0.7% of primary prostate malignancies. Leiomyosarcoma and rhabdomyosarcoma are the most common sarcomas of the prostate. Malignant peripheral nerve sheath tumor (MPNST) of the prostate is very rare. PATIENT CONCERNS A 22-year-old man presented with gross hematuria and voiding difficulty for 2 weeks. Magnetic resonance imaging showed a 6-cm mass in the left lobe of the prostate. DIAGNOSES Core needle biopsy results revealed high-grade sarcoma, suggestive of poorly differentiated synovial sarcoma. The final diagnosis of laparoscopic prostatectomy was MPNST, because it did not show the presence of SYT-SSX fusion transcripts on reverse transcription polymerase chain reaction analysis. INTERVENTIONS Adjuvant radiotherapy was planned because preoperative positron emission tomography-computed tomography (CT) did not show any metastatic lesion and the resection margin was microscopically involved. However, chest CT showed multiple lung metastases a month after prostatectomy. A chemotherapeutic regimen of doxorubicin and ifosfamide was administered. OUTCOMES The best response to chemotherapy was partial response. After several courses of chemotherapy, he died 9 months after the surgery. LESSONS Primary prostate sarcoma and even MPNST are extremely rare. MPNST of the prostate has seldom been reported. This report may help diagnose and manage the disease.
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Affiliation(s)
| | | | | | | | - Kyung Un Choi
- Department of Pathology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
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16
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Phenotypic appearances of prostate utilizing PET-MRI and PET-CT with 68Ga-PSMA, radiolabelled choline and 68Ga-DOTATATE. Nucl Med Commun 2018; 39:196-204. [PMID: 29384832 DOI: 10.1097/mnm.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to highlight the role of multimodality imaging and present the differential diagnosis of abnormal tracer accumulation in the prostate and periprostatic tissue. Our departments have performed molecular imaging of the prostate utilizing PET-CT and PET-MRI with a range of biomarkers including F-FDG, radiolabelled choline, Ga-DOTATATE PET-CT and Ga-PSMA images. We retrospectively reviewed the varying appearances of the prostate gland in different diseases and incidental findings in periprostatic region. The differential diagnosis of pathologies related to prostate and periprostatic tissue on multimodality imaging includes malakoplakia, rhabdomyosarcoma, lymphoma, prostate cancer, neuroendocrine tumours, uchida changes, rectoprostatic fistula, synchronous malignancies, lymphocoele and schwanoma. There exists a wide differential for abnormal tracer accumulation in the prostate gland. As a radiologist and nuclear medicine physician, it is important to be aware of range of prostatic and periprostatic pathologies.
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17
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Mullen JT, van Houdt W. Soft tissue tumors of the pelvis: Technical and histological considerations. J Surg Oncol 2017; 117:48-55. [DOI: 10.1002/jso.24943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/08/2017] [Indexed: 12/20/2022]
Affiliation(s)
- John T. Mullen
- Department of Surgery; Massachusetts General Hospital; Boston Massachusetts
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18
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Rao B.V, Nair H, Murthy S, Sharma R, Rao S. Prostatic High-Grade Stromal Sarcoma—A Rare Encounter. Indian J Surg Oncol 2017; 8:440-442. [DOI: 10.1007/s13193-017-0660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/20/2017] [Indexed: 10/19/2022] Open
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19
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Wang X, Tu X, Tan P, Zhan W, Nie P, Wei B, Li X, Chen L, Lu Y, Han P. Adult genitourinary sarcoma: Clinical characteristics and survival in a series of patients treated at a high-volume institution. Int J Urol 2017; 24:425-431. [PMID: 28470716 DOI: 10.1111/iju.13345] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/05/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To report our institutional experience in the management of adult genitourinary sarcoma. METHODS This was a retrospective analysis of data on adult genitourinary sarcoma treated at the West China Hospital, Sichuan University, Chengdu, Sichuan, China from 1985 to 2010. Clinicopathological parameters were analyzed to determine their impact on overall, recurrence-free and metastasis-free survivals. RESULTS A total of 46 women and 142 men were included, with a median age of 42 years. Of these, 152 cases were high-grade. The most common site was the paratesticular region. Surgical resection was carried out in 155 patients (82.4%), with negative margin in 106. After a minimum follow up of 5 years, 20 patients (11.6%) survived disease-free, 14 (8.1%) were alive with disease and 138 (80.2%) died of disease. Survival rates at 1, 3 and 5 years were 91.3%, 64.0% and 47.7%. In univariate analyses, liposarcoma, high grade, metastasis at diagnosis, a lack of surgical resection and positive margin were predictive of unfavorable survival. In multivariate analyses, high grade, a lack of surgical resection and chemotherapy were independent predictors of poor survival. CONCLUSIONS Adult genitourinary sarcoma is an aggressive malignancy, usually presenting at advanced stage, with a high incidence of recurrence and metastasis. Complete resection and selective combination of chemotherapy and radiotherapy might constitute the optimal treatment for this disease.
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Affiliation(s)
- Xianding Wang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Tu
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Ping Tan
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Wenli Zhan
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Pan Nie
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Bing Wei
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Li
- Department of Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Libo Chen
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yiping Lu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ping Han
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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20
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[Primary prostatic sarcoma - a rare malignancy]. Urologe A 2017; 56:857-860. [PMID: 28349187 DOI: 10.1007/s00120-017-0370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Primary prostatic sarcomas are rare, reportedly comprising less than 1% of all prostate malignancies. Most patients present with lower urinary tract symptoms due to bladder outlet obstruction. Prostate-specific antigen (PSA) is typically normal. Histological confirmation and staging by a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the pelvis and abdomen are essential for diagnosis and treatment planning. The differential diagnosis includes sarcomatoid prostate cancer or benign spindle cell tumors. Primary prostatic sarcomas are often aggressive and require multimodal treatment with surgery and (neo)adjuvant radiation and/or chemotherapy. The risk of local recurrence is high and the long-term prognosis is poor.
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21
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Abstract
Primary intraprostatic synovial sarcoma is a rare presentation of an otherwise well-studied disease, and it is one of the few primary sarcomas to occur in the prostate. Ancillary diagnostic techniques including immunohistochemistry and molecular genetics are useful to establish a definitive diagnosis. Despite its unorthodox location, it shares histologic and molecular genetic characteristics with tumors found elsewhere in the body. Most notably, the chromosomal translocation t(X;18)(p11;q11) encodes a chimeric transcription-activating protein, SS18-SSX, which has been identified as the primary driver mutation. The SS18-SSX fusion gene provides a consistent and dependable means of establishing a definitive diagnosis via reverse transcription-polymerase chain reaction or fluorescence in situ hybridization. Recent studies have continued to provide insight into the oncogenesis of this disease. The goal of this review is to elaborate on the clinicopathologic characteristics and underline those techniques that best facilitate the diagnosis of primary intraprostatic synovial sarcoma.
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22
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Abstract
PURPOSE OF REVIEW The purpose of this article was to describe the systemic therapy of genito-urinary sarcomas. RECENT FINDINGS High rate of distant metastasis and high mortality rate has brought interest into the development of new therapeutic approaches. Various modules of chemotherapy were sampled in sarcoma treatment, although clinical response is still unsatisfactory. Chemotherapy in sarcomas can be used as neoadjuvant or adjuvant to the surgery. There is no consensus on the current role of adjuvant chemotherapy. Study results are conflicting; therefore, conclusions drawn from the studies are uncertain. In general, the adjuvant chemotherapy is not standard treatment in adult-type sarcomas. In addition, chemotherapy for advanced and metastatic sarcoma disease, as well as second-line chemotherapy, was discussed. SUMMARY The best treatment for sarcomas in case of organ-confined disease and in selected cases of locally advanced disease seems to be surgery followed by chemotherapy. In case of metastasis stage of sarcoma, preoperative chemotherapy with surgery of residual masses should be considered as first-line treatment followed by postoperative chemotherapy. The treatment of patient with highly advanced disease and/or unresectable metastases should be individualized (chemotherapy, radiotherapy and best supportive care).
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23
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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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24
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Hicks N, Gurung PMS, Deshmukh N, Apakama I, Patel P. Primary prostate sarcoma: how to manage following diagnosis at transurethral resection. J Surg Case Rep 2016; 2016:rjw065. [PMID: 27147716 PMCID: PMC4855216 DOI: 10.1093/jscr/rjw065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Primary prostate sarcomas are rare, reportedly comprising just 0.7% of all prostate malignancies. Here, we present the case of a 66-year-old man who was diagnosed with prostate stromal sarcoma after undergoing a routine transurethral resection of prostate for bladder outflow obstruction. Primary prostate sarcoma can be aggressive even when low-grade, with a high risk of local recurrence and, high malignant potential when high-grade. They require aggressive multimodality treatment with surgery, chemotherapy and radiotherapy for durable survival outcomes. They also require close surveillance with long-term follow-up.
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Affiliation(s)
- Natalie Hicks
- Alexandra Hospital, Worcestershire Acute NHS Hospitals Trust, Redditch, UK
| | | | - Nayneeta Deshmukh
- Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | | | - Prashant Patel
- Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
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25
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Guo LEH, Xu HX, Fu HJ, Sun LP, Liu BJ. Contrast-enhanced ultrasound aids in the detection of prostate rhabdomyosarcoma: A case report and literature review. Oncol Lett 2015; 10:1541-1544. [PMID: 26622705 DOI: 10.3892/ol.2015.3449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 05/20/2015] [Indexed: 12/31/2022] Open
Abstract
Prostate sarcoma is a rare malignancy with an extremely poor prognosis. The extremely low morbidity and atypical clinical symptoms contribute to a missed diagnosis. The typical features of prostate sarcoma in transrectal ultrasound (US) and magnetic resonance imaging, such as a markedly enlarged volume and irregular prostatic contours, cannot usually be found until dysuria or even uroschesis occurs, and may then be too late to treat. However, there appears to no specific tumor marker for the disease in the serum. The present study reports a case of a young male patient who was diagnosed with prostate rhabdomyosarcoma. This was, to the best of our knowledge, the first case of this diagnosis using contrast-enhanced US (CEUS) when the symptoms were not severe. In this case, the intralesional non-enhancement areas and rim-like hyper-enhancement around the lesion were considered to be the main CEUS features of prostate rhabdomyosarcoma. The present study also reviews the associated literature.
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Affiliation(s)
- LE-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital of Tongji University, Shanghai 200072, P.R. China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital of Tongji University, Shanghai 200072, P.R. China
| | - Hui-Jun Fu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital of Tongji University, Shanghai 200072, P.R. China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital of Tongji University, Shanghai 200072, P.R. China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital of Tongji University, Shanghai 200072, P.R. China
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26
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Multimodal Therapy in the Treatment of Prostate Sarcoma: The Johns Hopkins Experience. Clin Genitourin Cancer 2015; 13:435-40. [DOI: 10.1016/j.clgc.2015.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 04/12/2015] [Accepted: 04/26/2015] [Indexed: 01/22/2023]
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27
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Sohn M, Kwon T, Jeong IG, Hong S, You D, Hong JH, Ahn H, Kim CS. Histologic variability and diverse oncologic outcomes of prostate sarcomas. Korean J Urol 2014; 55:797-801. [PMID: 25512813 PMCID: PMC4265713 DOI: 10.4111/kju.2014.55.12.797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/11/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose Primary prostate sarcomas are a rare type of prostate cancer that account for less than 0.1% of primary prostate malignancies. We analyzed the experience of a single institution with prostate sarcoma over 20 years. Materials and Methods In this case series, the medical records of 20 patients with prostate sarcoma were reviewed from June 1990 to December 2013 to identify symptoms at presentation, diagnostic procedures, metastasis presence and development, histologic subtype, French Fédération Nationale des Centres de Lutte Contre le Cancer grade, primary tumor grade and size, and treatment sequence, including surgery and preoperative and postoperative therapies. The average follow-up period was 23.6 months (range, 1.4-83.3 months). Results The average patient age was 46.3±16.7 years. Most patients presented with lower urinary tract symptoms (55%). The histologic subtype was spindle cell sarcoma in five patients (25%), rhabdomyosarcoma in three patients (15%), synovial sarcoma in three patients (15%), liposarcoma in three patients (15%), stromal sarcoma in three patients (15%), and Ewing sarcoma, nerve sheath tumor, and adenocarcinoma with sarcomatoid component (5% each). For liposarcoma, two patients were alive after complete surgical resection and had a good prognosis. At last follow-up, 15 patients had died of sarcoma. The 2- and 5-year actuarial survival rates for all 20 patients were 53% and 12%, respectively (medial survival, 20 months). Conclusions The disease-specific survival rate of prostate sarcoma is poor. However, sarcoma that is detected early shows a better result with proper management including surgical intervention with radio-chemotherapy than with no treatment. Early diagnosis and complete surgical resection offer patients the best curative chance.
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Affiliation(s)
- Mooyoung Sohn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Taekmin Kwon
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungwoo Hong
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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28
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Musser JE, Assel M, Mashni JW, Sjoberg DD, Russo P. Adult prostate sarcoma: the Memorial Sloan Kettering experience. Urology 2014; 84:624-8. [PMID: 25168544 DOI: 10.1016/j.urology.2014.05.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/09/2014] [Accepted: 05/28/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To present our institutional experience with adult prostate sarcoma over 30 years. MATERIALS AND METHODS We reviewed 38 cases of adult prostate sarcoma diagnosed and treated at our institution between 1982 and 2012. Univariate Cox proportional hazards regression was used to determine if there was an association between specific disease characteristics (tumor size, histology, American Joint Committee on Cancer stage, and metastasis at diagnosis) and cancer-specific survival (CSS). RESULTS A total of 38 patients were included, with a median age of 50 years (range, 17-73 years). Most men presented with lower urinary tract symptoms (45%), hematuria (24%), or acute urinary retention (21%). Diagnosis was established with prostate needle biopsy (68%) or transurethral resection of the prostate (18%). The predominant histologic subtypes were leiomyosarcoma (13 cases, 34%) and rhabdomyosarcoma (12 cases, 32%). Rhabdomyosarcoma was associated with poorer CSS (hazard ratio, 3.00; 95% confidence interval [CI], 1.13-7.92; P = .027) compared with leiomyosarcoma. We did not observe a significant relationship between tumor size and CSS. Overall, median CSS was 2.9 years (95% CI, 1.5-5.4), with 7.7 years for clinically localized disease (95% CI 2.5; upper bound not reached) and 1.5 years for metastatic disease (95% CI 1.1, 2.7). CONCLUSION Adult prostate sarcoma has a poor prognosis, especially in cases of metastatic disease at the time of diagnosis. Surgery remains the standard of care, but it provides limited benefit to those with metastatic disease or as a consolidation therapy after partial response to systemic therapy.
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Affiliation(s)
- John E Musser
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph W Mashni
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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