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Muacevic A, Adler JR, Mudiyanselage A, Janebdar H, Narula A, Banks F, Roux J, Vasdev N. A Rare Case of Prostatic Stromal Tumour of Uncertain Malignant Potential Surrounding Ejaculatory Ducts in a Patient With Concurrent Prostate Adenocarcinoma. Cureus 2022; 14:e31690. [PMID: 36561595 PMCID: PMC9764402 DOI: 10.7759/cureus.31690] [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] [Accepted: 11/19/2022] [Indexed: 11/21/2022] Open
Abstract
Stromal tumour of uncertain malignant potential (STUMP) is exceedingly rare. Diagnosis and management of STUMP present a challenge to the urologist due to the absence of specific clinical findings and its unpredictable clinical course. Thus, radical resection is often recommended. Here, we present a case of a 64-year-old male, who presented with mild obstructive voiding symptoms with a raised age-specific prostate-specific antigen (PSA) of 3.1. Magnetic resonance imaging (MRI) showed an area of suspicion, in an area thought to be the left seminal vesicle, containing a malignant lesion within it. Biopsy of this area and the prostate confirmed concurrent prostatic STUMP and Gleason 3+3=6 adenocarcinoma of the prostate, managed with robotic-assisted laparoscopic radical prostatectomy with wide local excision.
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2
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Hwangbo H, Kwon DH, Choi EO, Kim MY, Ahn KI, Ji SY, Kim JS, Kim KI, Park NJ, Kim BH, Kim GY, Hong SH, Park C, Jeong JS, Choi YH. Corni Fructus attenuates testosterone-induced benign prostatic hyperplasia by suppressing 5α-reductase and androgen receptor expression in rats. Nutr Res Pract 2018; 12:378-386. [PMID: 30323905 PMCID: PMC6172175 DOI: 10.4162/nrp.2018.12.5.378] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/27/2018] [Accepted: 06/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/OBJECTIVES Benign prostatic hypertrophy (BPH) is a major cause of abnormal overgrowth of the prostate mainly in the elderly. Corni Fructus has been reported to be effective in the prevention and treatment of various diseases because of its strong antioxidant effect, but its efficacy against BPH is not yet known. This study was designed to evaluate the therapeutic efficacy of Corni Fructus water extract (CF) in testosterone-induced BPH rats. MATERIALS/METHODS To induce BPH, rats were intraperitoneal injected with testosterone propionate (TP). Rats in the treatment group were orally administered with CF with TP injection, and finasteride, which is a selective inhibitor of 5α-reductase type 2, was used as a positive control. RESULTS Our results showed that the increased prostate weight and histopathological changes in BPH model rats were suppressed by CF treatment. CF, similar to the finasteride-treated group, decreased the levels of testosterone and dihydrotestosterone by TP treatment in the serum, and it also reduced 5α-reductase expression and concentration in prostate tissue and serum, respectively. In addition, CF significantly blocked the expression of the androgen receptor (AR), AR co-activators, and proliferating cell nuclear antigen in BPH rats, and this blocking was associated with a decrease in prostate-specific antigen levels in serum and prostate tissue. CONCLUSIONS These results suggest that CF may weaken the BPH status through the inactivation of at least 5α-reductase and AR activity and may be useful for the clinical treatment of BPH.
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Affiliation(s)
- Hyun Hwangbo
- Anti-Aging Research Center, Dongeui University, Busan 47340, Korea.,Open Laboratory for Muscular and Skeletal Disease and Department of Biochemistry, Dongeui University College of Korean Medicine, 42 San, Yangjungdong, Busan 47227, Korea
| | - Da He Kwon
- Anti-Aging Research Center, Dongeui University, Busan 47340, Korea.,Open Laboratory for Muscular and Skeletal Disease and Department of Biochemistry, Dongeui University College of Korean Medicine, 42 San, Yangjungdong, Busan 47227, Korea
| | - Eun Ok Choi
- Anti-Aging Research Center, Dongeui University, Busan 47340, Korea.,Open Laboratory for Muscular and Skeletal Disease and Department of Biochemistry, Dongeui University College of Korean Medicine, 42 San, Yangjungdong, Busan 47227, Korea
| | - Min Yeong Kim
- Anti-Aging Research Center, Dongeui University, Busan 47340, Korea.,Open Laboratory for Muscular and Skeletal Disease and Department of Biochemistry, Dongeui University College of Korean Medicine, 42 San, Yangjungdong, Busan 47227, Korea
| | - Kyu Im Ahn
- Anti-Aging Research Center, Dongeui University, Busan 47340, Korea.,Open Laboratory for Muscular and Skeletal Disease and Department of Biochemistry, Dongeui University College of Korean Medicine, 42 San, Yangjungdong, Busan 47227, Korea
| | - Seon Yeong Ji
- Anti-Aging Research Center, Dongeui University, Busan 47340, Korea.,Open Laboratory for Muscular and Skeletal Disease and Department of Biochemistry, Dongeui University College of Korean Medicine, 42 San, Yangjungdong, Busan 47227, Korea
| | - Jong Sik Kim
- Department of Anatomy, Kosin University College of Medicine, Busan 49267, Korea
| | - Kyung-Il Kim
- Gurye Sansooyu Farming Association Corporation, Jeonnam 57602, Korea
| | - No-Jin Park
- Gurye-gun Agricultural Center, Jeonnam 57660, Korea
| | - Bum Hoi Kim
- Department of Anatomy, Dongeui University College of Korean Medicine, Busan 47227, Korea
| | - Gi-Young Kim
- Laboratory of Immunobiology, Department of Marine Life Sciences, Jeju National University, Jeju 63243, Korea
| | - Su-Hyun Hong
- Anti-Aging Research Center, Dongeui University, Busan 47340, Korea.,Open Laboratory for Muscular and Skeletal Disease and Department of Biochemistry, Dongeui University College of Korean Medicine, 42 San, Yangjungdong, Busan 47227, Korea
| | - Cheol Park
- Department of Molecular Biology, College of Natural Sciences, Dongeui University, Busan 47340, Korea
| | - Ji-Suk Jeong
- Gurye-gun Agricultural Center, Jeonnam 57660, Korea
| | - Yung Hyun Choi
- Anti-Aging Research Center, Dongeui University, Busan 47340, Korea.,Open Laboratory for Muscular and Skeletal Disease and Department of Biochemistry, Dongeui University College of Korean Medicine, 42 San, Yangjungdong, Busan 47227, Korea
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3
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Tchrakian N, Browne E, Shanks JH, Flynn RJ, Crowther S. Phyllodes tumour of the urinary bladder: a report of a unique case. Histopathology 2017; 72:356-358. [DOI: 10.1111/his.13344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nairi Tchrakian
- Department of Histopathology; Tallaght Hospital; Dublin Ireland
| | - Eva Browne
- Department of Surgery; Tallaght Hospital; Dublin Ireland
| | - Jonathan H Shanks
- Department of Histopathology; The Christie NHS Foundation Trust; Manchester UK
| | - Robert J Flynn
- Department of Surgery; Tallaght Hospital; Dublin Ireland
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4
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Khurram MS, Tranesh G, Sakhi R, Hamza A, Ibrar W, Bano R. Metastatic prostatic stromal sarcoma: A challenging diagnosis on fine-needle aspiration with broad differential diagnosis. Cytojournal 2017; 14:15. [PMID: 28694836 PMCID: PMC5488594 DOI: 10.4103/cytojournal.cytojournal_46_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 02/13/2017] [Indexed: 11/24/2022] Open
Abstract
Prostatic stromal sarcomas (PSS) are rare solid organ mesenchymal sarcomas. PSS may pose difficult diagnostic challenges on fine needle aspiration biopsy. We report a 48-year-old man diagnosed with metastatic high grade prostatic stromal sarcoma by a CT-scan guided fine needle aspiration (FNA) biopsy of a right lower lung lobe nodule. We reviewed the literature on the epidemiologic, cyto-histological, and immunophenotypic findings and discussed the differential diagnosis for this rare entity.
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Affiliation(s)
| | | | - Ramen Sakhi
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Ameer Hamza
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Warda Ibrar
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Roohi Bano
- St. John Hospital and Medical Center, Detroit, MI, USA
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5
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Prostatic Stromal Tumor of Uncertain Malignant Potential Which Was Difficult to Diagnose. Case Rep Urol 2015; 2015:879584. [PMID: 26839730 PMCID: PMC4709648 DOI: 10.1155/2015/879584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/11/2015] [Accepted: 12/13/2015] [Indexed: 12/28/2022] Open
Abstract
Here, we report a case of stromal tumor of uncertain malignant potential (STUMP) that was difficult to diagnose. A 53-year-old male was found to have a hard nodule on digital rectal examination; magnetic resonance imaging revealed a large nodule on the left side of the prostate, indicating prostate cancer. However, pathological diagnosis of the biopsy specimen was benign prostatic hyperplasia. Although a papillary tumor in the prostatic urethra was also seen on urethrocystoscopy, the tumor specimen obtained from transurethral resection was not malignant. The tumor in the prostatic urethra recurred only 3 months after transurethral resection, and pathological findings revealed benign hyperplasia not only in the stromal tissue but also in the epithelium; therefore, the prostate tumor was suspected to be STUMP. It took many prostate pathologists a long time to reach the final diagnosis of STUMP. STUMP is a rare benign tumor, difficult to diagnose, and sometimes transforms into stromal sarcoma. Thus, we should consider radical resection in such cases.
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6
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Murer LM, Talmon GA. Stromal tumor of uncertain malignant potential of the prostate. Arch Pathol Lab Med 2015; 138:1542-5. [PMID: 25357117 DOI: 10.5858/arpa.2013-0212-rs] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Stromal tumor of uncertain malignant potential (STUMP) of the prostate is a rare tumor with a variable and unpredictable clinical course. Many STUMPs are diagnosed incidentally and never progress, while others may invade locally and rapidly recur after surgical intervention, and yet others may lead to distant metastasis and death. A wide array of histologic patterns is encompassed by STUMP, and distinguishing these tumors from prostatic stromal sarcoma or other causes of stromal expansion often proves difficult. Owing to the rarity of this tumor, there is not yet a consensus on appropriate management. However, owing to the possibility of aggressive behavior, close management and consideration of definitive resection is warranted.
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Affiliation(s)
- Lauren M Murer
- From the Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha
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7
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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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8
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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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9
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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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11
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Colombo P, Ceresoli GL, Boiocchi L, Taverna G, Grizzi F, Bertuzzi A, Santoro A, Roncalli M. Prostatic stromal tumor with fatal outcome in a young man: histopathological and immunohistochemical case presentation. Rare Tumors 2010; 2:e57. [PMID: 21234249 PMCID: PMC3019592 DOI: 10.4081/rt.2010.e57] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/14/2010] [Accepted: 09/22/2010] [Indexed: 01/11/2023] Open
Abstract
Stromal tumors of the prostate are rare and only a few cases have been described in the literature, including exceptional cases of stromal tumors with unknown malignant potential (STUMP) and a fatal outcome in young patients. Morphologically distinguishing a STUMP from a stromal sarcoma of the prostate (PSS) is still a challenge. We describe the histopathological and immunohistochemical findings in a 34-year-old man with a malignant specialized cell stromal tumor of the prostate that was diagnosed initially as STUMP, and he developed lung metastases within a few months. The patient attended our hospital because of lower urinary tract symptoms, after having excreted tissue through the urethra a few months before. Ultrasonography and urethrocystoscopy examinations showed a mass arising from the verumontanum, and a transurethral resection (TUR) revealed a highgrade spindle cell sarcoma reminiscent of a phyllode tumor of the breast. The tumor cells were immunoreactive for vimentin, progesterone receptor and, focally, CD34. The preliminary histological findings were subsequently confirmed after radical prostatectomy. The patient developed bilateral lung metastases and died 25 months after the initial diagnosis. Although rare in young patients, the challenging differential diagnosis of STUMP and PSS means that a prostate STUMP diagnosis made on the basis of biopsy or TUR specimens also requires urethrocystoscopic monitoring for the early detection of any progression to PSS. Radical prostatectomy should also be carefully considered.
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12
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Zambelli D, Cunto M, Raccagni R, Merlo B, Morini M, Bettini G. Successful surgical treatment of a prostatic biphasic tumour (sarcomatoid carcinoma) in a cat. J Feline Med Surg 2010; 12:161-5. [PMID: 19740688 PMCID: PMC10911443 DOI: 10.1016/j.jfms.2009.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2009] [Indexed: 10/20/2022]
Abstract
A 12-year-old, neutered male, mixed-breed, domestic cat was presented for dysuria and haematuria accompanied by recurrent dyschezia and constipation. At rectal digital examination a non-painful, globose and relatively immobile mass was detected at the pelvic brim, ventral to the rectum. Abdominal ultrasound showed the prostate replaced by a mass with a regular shape but patchy/non-uniform echogenicity. A prostatectomy followed by prepubic urethrostomy was performed. At histopathology the tumour was composed of epithelial ducts and acini with malignant features, surrounded by proliferating cellular stroma with mitoses and nuclear atypia; an immunohistochemical panel confirmed the biphasic nature of the tumour proliferation. The diagnosis was non-infiltrating malignant mixed tumour, resembling human sarcomatoid carcinoma of the prostate. Two years after surgery the animal has not shown any health problems. To the author's knowledge, this is the first reported case of prostatic tumour with a positive follow-up after surgical treatment in cat.
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Affiliation(s)
- Daniele Zambelli
- Veterinary Clinical Department, Obstetric-Gynecological Division, University of Bologna, Via Tolara di Sopra 50, 40064 Ozzano Emilia (BO), Italy.
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13
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Lee HY, Kim JJ, Ko ES, Kim SW, Lee SH, Kang HH, Park CK, Min KO, Lee BY, Moon HS, Kang JY. Prostatic Stromal Tumor of Uncertain Malignant Potential (STUMP) Presenting with Multiple Lung Metastasis. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.69.4.284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hea Yon Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin Jin Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Eun Sil Ko
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sei Won Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Haak Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyeon Hui Kang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chan Kwon Park
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki Ouk Min
- Department of Clinical Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Bae Young Lee
- Department of Radiology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hwa Sik Moon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Young Kang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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14
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Chung HC, Lee HS, Kim TI, Kim DI, Park KH, Song JM. A large cystic phyllodes tumor of the prostate. Yonsei Med J 2009; 50:174-6. [PMID: 19259368 PMCID: PMC2649865 DOI: 10.3349/ymj.2009.50.1.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 11/06/2008] [Indexed: 11/30/2022] Open
Abstract
We report a 65 year-old man with a large cystic phyllodes tumor of the prostate. The patient complained of abdominal discomfort and had a soft palpable mass. Computer tomography showed a solid and cystic mass in the pelvic fossa; the mass was adjacent only to the prostate. We excised the mass. Microscopic findings of the mass showed hyperplastic epithelium lined cysts with leaf-like intraluminal epithelia lined stromal projections, less than 2 mitotic counts/10 HPF, low-to-moderated cellularity, and mild-to-moderate cytoplasm atypia. The pathological findings were consistent with a phyllodes tumor of the prostate, a low-grade tumor. Twenty-eight months after the operation, the patient was well with no recurrence or metastases.
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Affiliation(s)
- Hyun Chul Chung
- Department of Urology, Yonsei University Wonju Collage of Medicine, Wonju, Korea
| | - Hyo Serk Lee
- Department of Urology, Yonsei University Wonju Collage of Medicine, Wonju, Korea
| | - Tae Im Kim
- Department of Urology, Yonsei University Wonju Collage of Medicine, Wonju, Korea
| | - Dae Il Kim
- Department of Urology, Yonsei University Wonju Collage of Medicine, Wonju, Korea
| | - Kwang Hwa Park
- Department of Pathology, Yonsei University Wonju Collage of Medicine, Wonju, Korea
| | - Jae Mann Song
- Department of Urology, Yonsei University Wonju Collage of Medicine, Wonju, Korea
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Morikawa T, Goto A, Tomita K, Tsurumaki Y, Ota S, Kitamura T, Fukayama M. Recurrent prostatic stromal sarcoma with massive high-grade prostatic intraepithelial neoplasia. J Clin Pathol 2007; 60:330-2. [PMID: 17347288 PMCID: PMC1860576 DOI: 10.1136/jcp.2006.039032] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A unique case of prostatic stromal sarcoma (PSS) that recurred in the pelvic cavity with massive high-grade prostatic intraepithelial neoplasia is described. A 52-year-old man who presented with urinary retention underwent a radical cystoprostatectomy. Tumour tissues of the prostate showed an admixture of hyperplastic glands and markedly cellular stroma of spindle cells arranged in a fascicular pattern, and the tumour was diagnosed as PSS. 66 months after the operation, CT scans revealed three recurrent tumours around the bilateral obturator and left fore iliopsoas. The recurrent tumours were biphasic neoplasms, as before, but the epithelial component had grown prominent and manifested overt atypia in a manner resembling high-grade prostatic intraepithelial neoplasia. Our findings suggest that not only the stromal component but also and the epithelial components of PSS may have malignant potential.
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Affiliation(s)
- Teppei Morikawa
- Department of Human Pathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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16
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Herawi M, Epstein JI. Specialized stromal tumors of the prostate: a clinicopathologic study of 50 cases. Am J Surg Pathol 2006; 30:694-704. [PMID: 16723846 DOI: 10.1097/00000478-200606000-00004] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Specialized stromal tumors of the prostate encompass stromal sarcoma and stromal tumors of uncertain malignant potential (STUMP). As a result of their relative rarity and lack of long-term follow-up, the prognosis of STUMP is unclear. We studied 50 cases of STUMP and stromal sarcoma with regard to their clinical presentation and follow-up. Patients ranged in age from 27 to 83 years (mean 58 years). The major presenting signs and symptoms were urinary obstructive symptoms (n=25), abnormal digital rectal exam (n=15), hematuria (n=7), hematospermia (n=1), and rectal dysfunction/fullness (n=3). An elevated prostate-specific antigen was either the sole or a compounding rationale for initial urologic examination and prostate biopsy in a subgroup of patients (n=11). The histology in the 36 cases of STUMP not associated with sarcoma were as follows: 25 composed of stroma with scattered cytologically atypical cells associated with benign glands; 8 resembling glandular-stromal hyperplasia but with hypercellular stroma; 6 with extensive myxoid stroma; and 1 with phyllodes pattern. Four of these cases had mixed patterns. Seven cases of STUMP were associated with sarcoma, either concurrently or subsequently. In another 7 cases, pure sarcomas were encountered: 3 low grade (LG) and 4 high grade (HG). In 19 STUMPs, the location of the lesion was determinable: 10 cases arose in the peripheral zone, 7 cases were located in the transition zone, and 2 cases seemed to involve both zones. In 3 of these cases, tumors were adherent to the rectum at the time of resection. There was no evidence of progression of disease for 14 STUMPs after biopsy, TUR, or enucleation where follow-up ranged from 0.3 to 14 years (mean 4.9 years). Five cases of STUMP showed local tumor growth: 1 case increased in size from 6 to 7.5 cm in 3 years and 4 cases recurred frequently necessitating multiple TURs of the prostate (n=2, n=3, n=3, n=3) over 1.1, 2, 7, and 8 years, respectively. Fourteen patients with STUMP underwent radical prostatectomy (RP) soon after diagnosis; of these, 12 were organ confined where the tumor size ranged from 0.7 to 7.5 cm (mean 2.7 cm); 2 cases with a history of a 28 g TUR and a 275 g enucleation showed no residual tumor in the RP specimen. Three cases were lost to follow-up. The histologic subtypes of STUMP did not correlate with the clinical behavior or likelihood of being associated with sarcoma. Two of the LG sarcomas locally invaded around the seminal vesicle, yet all of the LG sarcomas with follow-up were free of disease at 3, 13, 24, 25, 30, and 36 months. Of the 6 HG sarcomas with follow-up, 3 were free of disease at 3, 17, and 72 months. One man was alive with metastasis to the lung 10 months after RP, 1 man was alive at 280 months with multiple metastases, and another died of disease at 115 months. STUMPs can recur frequently, occur at a young age, often involve the peripheral zone where they can be adherent to the rectum requiring its removal, and can be associated with stromal sarcoma. Although STUMPs can be histologically misdiagnosed as nodular hyperplasia, it is important to recognize that these are neoplasms with unique local morbidity and malignant potential. Whereas LG stromal sarcomas can locally invade, HG sarcomas can metastasize and lead to death.
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Affiliation(s)
- Mehsati Herawi
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA
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17
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Morikawa T, Nagata M, Tomita K, Kitamura T, Goto A, Chong JM, Fukayama M. Phyllodes tumor of the prostate with exuberant glandular hyperplasia. Pathol Int 2006; 56:158-61. [PMID: 16497250 DOI: 10.1111/j.1440-1827.2006.01938.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Reported herein is an unusual case of prostatic phyllodes tumor with exuberant glandular hyperplasia that led to misdiagnosis of adenocarcinoma. The tumor was detected in a 52-year-old man who had a 1 year history of dysuria. Adenocarcinoma of the prostate was diagnosed from a needle biopsy specimen. The patient received hormonal therapy for 6 months and underwent radical prostatectomy. Histologically, the tumor had an atypical stromal cell proliferation and elongated slit-like glands characteristic of a phyllodes tumor. The tumor was also accompanied by a florid proliferation of small acini, most of which lacked basal cells, a common manifestation of adenocarcinoma in the overall tumor area. The following features of the resected tumor were helpful for concluding that these acini were benign: lack of cytological anaplasia in spite of structural atypia, presence of scattered basal cells confirmed by immunohistochemistry (high-molecular-weight cytokeratin), and histological transition from these acini to apparently benign slit-like glands. The final diagnosis was then made as 'phyllodes tumor of the prostate with exuberant glandular hyperplasia'. Atypical stromal cells might provide a clue for the recognition of this rare tumor at initial diagnosis by needle biopsy.
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Affiliation(s)
- Teppei Morikawa
- Department of Human Pathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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18
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Abstract
We report the case of a 47-year-old male patient who suffered from a malignant phyllodes tumor of the prostate with invasion to the rectum and urinary bladder. The local recurrence at the left scrotum was identified 6 years after radical cystoprostatectomy. Another 2 years after radical orchiectomy showed no evidence of secondary local recurrence or distant metastasis. Histopathologically, both primary and recurrent tumors showed an admixture of stromal and glandular components. However, while extensive squamous metaplasia was identified in the primary tumor, the recurrent tumor had only focal and mild squamous metaplasia. No dependable prognostic factor has been found to date. Here, we describe the morphological features and immunohistochemical presentations of malignant phyllodes tumor of the prostate and review the literature.
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Affiliation(s)
- Tau-An Chen
- Pathology, Tri-Service General Hospital, Taipei, Taiwan
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McCarthy RP, Zhang S, Bostwick DG, Qian J, Eble JN, Wang M, Lin H, Cheng L. Molecular genetic evidence for different clonal origins of epithelial and stromal components of phyllodes tumor of the prostate. THE AMERICAN JOURNAL OF PATHOLOGY 2004; 165:1395-400. [PMID: 15466403 PMCID: PMC1618623 DOI: 10.1016/s0002-9440(10)63397-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Phyllodes tumor of the prostate is a rare neoplasm, composed of epithelium-lined cysts and channels embedded in a variably cellular stroma. The pathogenetic relationship of the epithelium and stroma is unknown and whether each is a clonal neoplastic element is uncertain. We studied the clonality of phyllodes tumors from six patients who underwent either enucleation or transurethral resection as their initial treatment. This was followed by total prostatectomy in three of the patients. Laser-assisted microdissection was performed to extract epithelial and stromal components of phyllodes tumor from formalin-fixed, paraffin-embedded tissue. Polymerase chain reaction was used to amplify genomic DNA at specific loci on chromosome 7q31 (D7S522), 8p21.3-q11.1 (D8S133, D8S137), 8p22 (D8S261), 10q23 (D10S168, D10S571), 17p13 (TP53), 16q23.2 (D16S507), 12q11-12 (D12S264), 17q (D17S855), 18p11.22-p11 (D18S53), and 22q11.2 (D22S264). In each tumor, stroma and epithelium were analyzed separately. Gel electrophoresis with autoradiography was used to detect loss of heterozygosity. All tumors showed allelic loss in one or more loci of both the epithelial and stromal components. The frequency of allelic loss in the epithelial component was 2 of 5 (40%) at D7S522, 2 of 6 (33%) at D8S133, 1 of 5 (20%) at D8S137, 3 of 6 (50%) at D8S261, 4 of 4 (100%) at D10S168, 4 of 6 (67%) at TP53, 2 of 6 (33%) at D10S571, 6 of 6 (100%) at D16S507, 1 of 5 (20%) at D12S264, 1 of 6 (17%) at D17S855, 2 of 6 (33%) at D18S53, and 2 of 5 (40%) at D22S264. The frequency of allelic loss in the stromal component was 2 of 5 (40%) at D7S522, 1 of 6 (17%) at D8S133, 2 of 5 (40%) at D8S137, 3 of 6 (50%) at D8S261, 1 of 4 (25%) at D10S168, 3 of 6 (50%) at TP53, 2 of 6 (33%) at D10S571, 3 of 6 (50%) at D16S507, 1 of 5 (20%) at D12S264, 0 of 6 (0%) at D17S855, 1 of 6 (17%) at D18S53, and 0 of 5 (0%) at D22S264. The pattern of allelic loss is significantly different in both stroma and epithelium statistically; completely concordant allelic loss patterns were not seen in any tumor examined. Our data demonstrate that both epithelial and stromal components of phyllodes tumor of the prostate are clonal, supporting the hypothesis that both elements are neoplastic. While both epithelium and stroma are clonal proliferations, they appear to have different clonal origins.
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Affiliation(s)
- Ryan P McCarthy
- Department of Pathology and Laboratory Medicine, Indiana University Medical Center, University Hospital 3465, 550 North University Blvd., Indianapolis, IN 46202, USA
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Bostwick DG, Hossain D, Qian J, Neumann RM, Yang P, Young RH, di Sant'agnese PA, Jones EC. Phyllodes tumor of the prostate: long-term followup study of 23 cases. J Urol 2004; 172:894-9. [PMID: 15310992 DOI: 10.1097/01.ju.0000134580.71261.57] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Phyllodes tumor of the prostate is a rare neoplasm of uncertain malignant potential. We studied a large series of phyllodes tumors to define the combination of histological features that are most useful for predicting patient outcome. MATERIALS AND METHODS A total of 23 cases were obtained from our collective files from 1973 to 2002, and numerous clinical and pathological features were evaluated. A review of the reported cases of phyllodes tumor of the prostate was done. RESULTS Patient age was 25 to 86 years (mean 55) and they usually presented with urinary obstructive symptoms and hematuria. The diagnosis was made in 18 tumors by transurethral resection, in 2 by enucleation, in 1 by tumor resection and in 2 by prostatectomy. We analyzed 5 histological features, including cellularity (scale of 1 to 3), cytologic atypia (scale of 1 to 3), the number of mitotic figures per 10 high power fields, the stroma-to-epithelium ratio (low or high) and necrosis (present or absent). This combination of features revealed that 14 cases were low grade phyllodes tumor, 7 were intermediate grade and 2 were high grade with the high grade cases characterized by increased cellularity, severe cytological atypia, more than 5 mitotic figures per 10 high power fields and a high stroma-to-epithelium ratio, indicating stromal overgrowth. Immunohistochemical studies of 8 tumors revealed consistent, intense cytoplasmic immunoreactivity in stromal cells for vimentin and actin, in luminal epithelial cells for prostate specific antigen, prostatic acid phosphatase and broad-spectrum keratin AE1/AE3, and in basal cells for high molecular weight keratin 34beta-E12. Recurrence was seen in 7 of 14 low grade tumors (50%) and in 1 patient low grade sarcoma emerged with subsequent distant metastases 14 years after initial diagnosis following 5 recurrences. Recurrence was seen in 6 of 7 intermediate grade tumors and low grade sarcoma emerged with subsequent abdominal wall metastases in 1 patient 11 years after initial diagnosis following 3 recurrences. The phyllodes tumor recurred in each patient with high grade tumors with a time to first recurrence of 6 and 0.2 years, respectively. Distant metastases developed in these 2 patients. CONCLUSIONS Histological grading of prostatic phyllodes tumors is predictive of short-term outcome based on the combination of stromal cellularity, cytological atypia, number of mitotic figures and the stroma-to-epithelium ratio. However, these tumors usually recur after transurethral prostatic resection and they are often locally aggressive with time. The emergence of overt sarcoma and metastatic disease is more frequent than previously recognized. Complete resection at initial diagnosis appears to be indicated.
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Affiliation(s)
- David G Bostwick
- Bostwick Laboratories, 2807 North Parham Road, Richmond, VA 23294, USA.
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