Burkitt's lymphoma mimicking prostatitis

Burkitt's lymphoma of the prostate presenting as acute urinary retention: a case report

Background

Non-Hodgkin lymphomas, which include Burkitt’s lymphoma, affect the prostate in only 0.1% of cases. They most commonly present as painless lymphadenopathy elsewhere in the body and can cause abdominal or thoracic pain and systemic symptoms such as fever, weight loss and night sweats. Here we report a rare case of sporadic Burkitt’s lymphoma of the prostate whose initial clinical presentation was acute urinary retention.

Case presentation

A 28-year-old Caucasian male presented repeatedly with urinary retention. First, he was misdiagnosed with alcohol-induced urinary retention and later with benign prostatic hyperplasia. After the appearance of new symptoms, including hematuria and hydronephrosis, endoscopic and radiographic evaluation was performed. Transurethral biopsy of the prostate secured the diagnosis of Burkitt’s lymphoma. The symptoms receded under chemotherapy and complete remission of the disease was established.

Conclusion

This case report brings lymphomas into focus as a differential diagnosis for urinary retention in young males. Early use of extensive diagnostic measures is advised in patients with urinary retention for uncertain reasons to make prompt diagnosis and start appropriate treatment early.

Do not Forget Burkitt´s Lymphoma! Unusual Case of Primary Malignant Lymphoma of the Prostate in a Young Patient

Primary Burkitt´s lymphoma (BL) of the prostate is rare in the adolescent population. The etiology remains poorly understood. There has been some proposed associations to Epstein-Barr virus and HIV. Clinical and histopathologic data of a 17-year-old patient who underwent transurethral resection of the prostate was obtained. We report the first case of primary malignant BL of the prostate in a 17-year-old Caucasian male who presented with hematuria, lower urinary tract symptoms. Differential diagnosis of a prostatic mass in adolescent patients must be primary or secondary lymphoma of the prostate, including BL as described for the first time in this article.

Collapsin response mediator protein 4 promotor methylation level as a potential predictor for diagnosing primary malignant lymphoma of the prostate

Background

Primary malignant lymphoma of the prostate (PMLP) is prone to occur in the elderly, and it has no significant correlation with lactate dehydrogenase (LDH) and prostate specific antigen (PSA). Clinical symptoms and imaging data of PMLP remain unspecific, and its prognosis is poor. A previous result showed that collapsin response mediator protein 4 (CRMP4) promotor methylation can be used as a predictor for lymph node metastases in prostate biopsies. However, the relationship between CRMP4 promotor methylation and PMLP has not been studied.

Methods

We investigated the clinicopathological features of PMLP and the significance of CRMP4 methylation in PMLP. The clinical data and diagnosis information of 10 patients with PMLP were retrospectively analyzed. The CRMP4 promotor methylation level in paraffin-embedded tissues of the 10 patients with PMLP were determined and then compared to limited prostate cancer (LPCa) and its negative lymph node tissue [LPCa-LN (−) (10 cases)] and also to metastatic prostate adenocarcinoma (mPCa) and its positive lymph node tissue [mPCa-LN (+) (10 cases)]. Methylation of the CRMP4 promotor in each group was analyzed statistically. A receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of CRMP4 methylation in PMLP.

Results

The average methylation value of CRMP4 in 10 PMLP patients, 20 cases of prostate adenocarcinoma tissue, 10 cases LPCa-LN (−) and 10 cases mPCa-LN (+) were 42.3, 30.6, 6.7 and 20.3%, respectively. A Kruskal–Wallis test showed that the difference of CRMP4 methylation was significant (X² = 38.0, P < 0.001). An ROC curve analysis found that CRMP4 methylation > 40.9% could diagnose PMLP. This method had 90% sensitivity and 95% specificity under conditions of CRMP4 methylation > 40.9%. The area under the curve (AUC) was 0.957.

Conclusions

Methylation of the CRMP4 gene was significantly increased in PMLP, and it is expected to become a new predictor for PMLP.

Non-epithelial neoplasms of the prostate

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.

FDG PET/CT imaging suggests lymphoma involving prostate may be more resistant to treatment

FDG PET imaging is generally not useful for prostate cancer. Nevertheless, incidental intense FDG uptake in the prostate warrants further evaluation to assess for prostatic malignancy. We report a case where intense FDG uptake was incidentally noted in an enlarged prostate on FDG PET/CT scan performed for a large left hilar/mediastinal mass (that was also intensely FDG avid along with several additional FDG-avid lesions elsewhere). Biopsy of the prostate and mediastinal lesions revealed large B-cell non-Hodgkin lymphoma at both sites. Serial FDG PET/CT imaging in this patient revealed that the prostatic lymphomatous lesions showed a slower and incomplete response to chemotherapy compared with other sites of lymphomatous involvement (that showed a rapid and complete response to chemotherapy) in the same patient.

[Prostatic lymphoma and review of the literature]

Prostatic lymphoma is an exceptional pathology, that usually is diagnosed because its prostatic symthomatology or as consequence of its invasion by an extraprostatic lymphoma. We present a case of a patient affected by a prostatic lymphoma and we perform a review of the literature in order to establish the diagnostic and therapeutic steps.

Nonepithelial Tumors and Tumor-Like Lesions of the Prostate Gland

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.

[Primary lymphoma of the prostate: report of a clinico-pathological case and review of the literature]

Lymphoma involving the prostate is rare, wether presenting as primary extranodal lymphoma or as a secondary spread to the prostate from other sites. There are less than 100 cases reported in the literature and accounts for 0.09-0.1%. The clinical presentation can be attributed to nodular hyperplasia or prostatic carcinoma. Criteria for primary prostatic lymphoma include: 1) tumor limited to the prostate and adjacent soft tissues. 2) the absence of lymph node involvement. 3) a lymphoma free interval of at least 1 month. The evolution is rapid and the prognosis remains poor regardless of the patient age, histologic type, treatment, or clinical stage of disease at presentation. We report a case of a 65 years old male in which the incidental diagnosis of lymphoma of the prostate was performed in the adenomectomy. The clinico-pathological criteria and the histogenesis of this entity are described.

Primary lymphoma of the prostate: good outcome with doxorubicin-based combination chemotherapy

Primary lymphoma of the prostate was diagnosed in 3 patients corresponding to 0.1% of those with previously untreated lymphoma and 0.09% of those with previously untreated prostatic malignancy presenting to our cancer center between January 1, 1980 and December 31, 1993. All 3 patients had prostatism at presentation that caused renal failure in 2. After treatment with doxorubicin-based combination chemotherapy appropriate for the stage and the specific histological subtype, all 3 patients achieved a complete remission and remained free of disease after a minimum followup of 3 years. Our results suggest that primary prostatic lymphoma is not necessarily associated with a poor outcome. Review of the literature suggests that the poor prognosis reported for prostatic lymphoma might be explained by treatment that was acceptable at the time but would be considered suboptimal by current criteria. We recommend thorough staging in all patients with prostatic lymphoma and treatment with a doxorubicin-based regimen according to disease stage and histological classification.

Hodgkin's disease of the prostate: a detailed case report

Malignant lymphoma of the prostate is an unusual entity, and nonHodgkin's lymphoma constitutes most reported cases. We report a well documented case of Hodgkin's lymphoma, initially involving the gastrointestinal tract and spleen, which recurred in the prostate following initial remission with chemotherapy. Treatment with external beam radiotherapy resulted in a rapid complete response that has been sustained for 18 months.

Malignant lymphomas involving the prostate. A study of 13 cases

The clinical and pathologic findings in 13 cases of malignant lymphoma involving the prostate gland were reviewed. The lymphomas tended to occur in elderly men with a mean age of 60 years (range, 30-86 years) and were clinically manifested by prostatic enlargement with urinary obstruction. In only one of the patients was there clinical suspicion of lymphoma before surgery. Seven patients had primary extranodal lymphoma of the prostate, with a variety of histologic subtypes, including small cell lymphocytic (one patient), diffuse small cleaved cell (two patients), diffuse mixed small and large cell (two patients), diffuse large non-cleaved cell (one patient), and high-grade diffuse small non-cleaved cell (undifferentiated non-Burkitt's) (one patient). At the time of presentation, none of these patients had hepatosplenomegaly, inguinal lymphadenopathy, abnormal complete blood counts, or elevated serum acid phosphatase levels. Six other patients with previously documented malignant lymphoma at other sites had prostatic involvement 2 to 60 months (mean, 14 months) after the primary diagnosis. Histologically, these secondary prostatic lymphomas included diffuse small cleaved cell (two patients), diffuse mixed small and large cell (one patient), diffuse large non-cleaved cell (two patients), and large cell immunoblastic, polymorphous type (T-cell by immunotyping) (one patient). The mean survival was 14 months for all patients (range, 2-44 months), with no apparent difference between primary and secondary involvement. One patient remains alive 44 months after secondary prostatic involvement with diffuse large non-cleaved cell lymphoma. Although malignant lymphomas involving the prostate are rare, they should be included in the differential diagnosis of lower urinary tract obstruction, particularly in patients with a previous history of lymphoma.

Non-Hodgkin lymphoma arising in lower urinary tract

Primary involvement of the bladder and prostate by non-Hodgkin lymphoma is exceedingly rare. Usually bladder lymphoma can be cured by aggressive local therapy, but the prognosis of prostatic lymphoma is poor. The devastating clinical course of a young man with primary lymphoma involving the prostate and bladder base is reported to emphasize the heterogeneity of this group of tumors and to encourage precise tumor classification. Prognosis depends on the tumor stage and the specific lymphoma cell-type as defined by conventional histologic and immunologic criteria. Management should be tailored according to tumor grade, stage, and site.