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Rockmore J, McIntosh G, Pui JC, Mohammaed S, Elgin R. A Rare Primary Osteogenic Sarcoma of the Prostate and Bladder. Cureus 2021; 13:e15689. [PMID: 34277278 PMCID: PMC8284180 DOI: 10.7759/cureus.15689] [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] [Accepted: 06/16/2021] [Indexed: 11/05/2022] Open
Abstract
Mesenchymal tumors of the genitourinary tract account for 5% percent of bladder malignancies and there are currently 35 documented cases of osteosarcoma type. Concomitant involvement of the prostate in mesenchymal genitourinary malignancies is even rarer. Herein we describe a case of a 72-year-old male with a history of radiation for prostate cancer who develops hematuria. A hematuria evaluation revealed osteosarcoma of the bladder and prostate. He underwent radical cystoprostatectomy with ileal conduit and adjuvant chemotherapy. His disease progressed despite treatment and he elected palliative care 10 months after initial resection. This case reviews a rare histological variant of genitourinary malignancy.
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Affiliation(s)
- Jesse Rockmore
- Urology, Mclaren Macomb/Michigan State University College of Osteopathic Medicine, Clinton Township, USA
| | - Gregory McIntosh
- Department of Urology, Michigan Institute of Urology, Macomb, USA
| | - John C Pui
- Pathology, Beaumont Health, Farmington Hills, USA
| | | | - Robert Elgin
- Department of Urology, Michigan Institute of Urology, Macomb, USA
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Bostwick DG, Egevad L. Prostatic stromal proliferations: a review. Pathology 2020; 53:12-25. [PMID: 33190920 DOI: 10.1016/j.pathol.2020.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
Prostatic stromal proliferations account for the majority of benign tumour-like lesions in the prostate. The most common is nodular hyperplasia, seen in a majority of elderly men. Diagnostic difficulty is encountered with some variants, including stromal hyperplasia with atypia, characterised by degenerative changes of myofibroblasts. In contrast with benign stromal tumours, malignant stromal tumours of the prostate are rare, accounting for less than 0.1% of all prostatic malignancies. The most common are rhabdomyosarcoma (paediatric) and leiomyosarcoma (adults); others include phyllodes tumour and stromal sarcoma. Some authors lump malignant tumours with poor outcome (e.g., phyllodes tumour and stromal sarcoma) with benign stromal tumours (e.g., stromal hyperplasia with atypia, leiomyoma), considering them collectively to be of uncertain malignant potential, but this approach is discouraged. This review presents a contemporary approach to classification and diagnosis of prostatic stromal tumours.
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Affiliation(s)
- David G Bostwick
- Bostwick Laboratories, A Division of Poplar Healthcare, Orlando, FL, USA.
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
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Wakabayashi K, Konishi K, Komatsu T, Ishiba R, Ota N, Ito T, Aki R, Tsuchida T, Miyake H, Nakamura K. Radiation-induced sarcoma after radiation therapy for prostate adenocarcinoma. IJU Case Rep 2019; 2:98-101. [PMID: 32743384 PMCID: PMC7292172 DOI: 10.1002/iju5.12052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/09/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Radiation therapy is widely used for prostate cancer, but radiation‐induced sarcomas have been rarely reported. Case presentation A 77‐year‐old Japanese male was diagnosed with prostate cancer and received a combined androgen blockade and radiation therapy (total dose of 76 Gy). Five years after the radiation therapy, testicular pain and dysuria appeared. Computed tomography showed a soft tissue dense mass with invasion to the right subpubic ramus and prostate, mainly to the perineum. A needle biopsy revealed the pathological features of high‐grade sarcoma. The patient was diagnosed with radiation‐induced sarcoma based on the cancer's occurrence in the vicinity of the radiation field. Conclusion Although irradiation is one of the important treatments for prostate cancer, the risk of radiation‐induced malignancy should be considered.
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Affiliation(s)
- Kohei Wakabayashi
- Department of Radiation Oncology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | - Kenta Konishi
- Department of Radiation Oncology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | - Tetsuya Komatsu
- Department of Radiation Oncology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | - Ryo Ishiba
- Department of Radiation Oncology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | - Naofumi Ota
- Department of Radiation Oncology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | - Toshiki Ito
- Department of Urology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | - Ryota Aki
- Department of Urology Hamamatsu Medical Center Hamamatsu Shizuoka Japan
| | - Takashi Tsuchida
- Department of Pathology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | - Hideaki Miyake
- Department of Urology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | - Katsumasa Nakamura
- Department of Radiation Oncology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
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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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Silva CHW, Claros OR, Amselem I, Sá NS, Fugita OEH. Spindle-cell carcinoma of the prostate. AUTOPSY AND CASE REPORTS 2012; 2:55-61. [PMID: 31528563 PMCID: PMC6735638 DOI: 10.4322/acr.2012.009] [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: 02/27/2012] [Accepted: 03/03/2012] [Indexed: 11/24/2022] Open
Abstract
Sarcoma of the prostate and sarcomatoid carcinoma of the prostate are rare conditions, both characterized by a poor prognosis. Sarcomatoid carcinoma of the prostate typically arises from the evolution of an underlying adenocarcinoma, occasionally featuring heterologous elements, bulky disease being possible but rare. In contrast, sarcoma of the prostate derives from non-epithelial mesenchymal components of the prostatic stroma, shows rapid growth, and frequently presents as massive pelvic tumors obstructing the urinary tract at the time of diagnosis. We report the case of a 55-year-old patient with a two-month history of symptoms of urinary obstruction. The patient presented with an extremely enlarged heterogeneous prostate, although his prostate-specific antigen level was low. The lack of a history of prostatic neoplasia led us to suspect sarcoma, and a transrectal prostate biopsy was carried out. An immunohistochemical study of the biopsy specimen did not confirm the clinical suspicion. However, in view of the clinical features, we believe that sarcoma of the prostate was the most likely diagnosis. The patient received neoadjuvant chemotherapy followed by radiation therapy. At this writing, surgical resection had yet to be scheduled.
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Affiliation(s)
| | - Oliver Rojas Claros
- Department of Surgery - Hospital Universitário - Universidade de São Paulo - São Paulo/SP - Brazil
| | - Isaac Amselem
- Department of Urology - Hospital São Camilo - Santana - São Paulo/SP - Brazil
| | - Newton Soares Sá
- Department of Urology - Hospital São Camilo - Santana - São Paulo/SP - Brazil
| | - Oscar Eduardo Hidetoshi Fugita
- Department of Surgery - Hospital Universitário - Universidade de São Paulo - São Paulo/SP - Brazil.,Department of Urology - Hospital São Camilo - Santana - São Paulo/SP - Brazil
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Affiliation(s)
- Fabio Tavora
- Department of Pathology, The John Hopkins Hospital, Baltimore, MD 21231, USA
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Abstract
Prostatic mesenchymal tumors encompass various benign and malignant neoplasms that may derived from the intrinsic prostatic stroma or from associated elements including muscle, connective tissue, blood vessels, and neural structures. The differential diagnosis of these tumors is broad and encompasses prostatic epithelial processes that demonstrate prominent spindle cell morphology, as well as mesenchymal tumors that secondarily involve the prostate. Careful morphologic examination, clinical history, and judicious use of a limited panel of immunohistochemical markers and molecular tests aid in the proper diagnosis of these lesions. This article provides a structured guide for the analysis and diagnosis of both benign and malignant prostatic mesenchymal lesions and highlights key features that distinguish these entities within the differential diagnosis of prostatic spindle cell lesions.
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Affiliation(s)
- Donna E Hansel
- Department of Anatomic Pathology, The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, The Cleveland Clinic, Cleveland, OH, USA; Glickman Urological and Kidney Institute, The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, The Cleveland Clinic, Cleveland, OH, USA; Taussig Cancer Institute, The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, The Cleveland Clinic, Cleveland, OH, USA.
| | - George J Netto
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Urology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Elizabeth A Montgomery
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jonathan I Epstein
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Urology, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD, USA
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Tong GX, Hamele-Bena D, Liu JC, Horst B, Remotti F. Fine-needle aspiration biopsy of primary osteosarcoma of the thyroid: report of a case and review of the literature. Diagn Cytopathol 2008; 36:589-94. [PMID: 18618703 DOI: 10.1002/dc.20840] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Primary osteosarcoma of the thyroid is an extremely rare tumor, with only 27 well-documented cases reported in the literature, including only one in the cytology literature. We describe here an additional case with fine-needle aspiration biopsy findings. A 60-year-old woman presented with a 1-month history of progressive midline neck swelling. CT and ultrasound demonstrated a large thyroid mass with tracheal compression. Fine-needle aspiration biopsies were performed and showed pleomorphic spindle and epithelioid neoplastic cells, multinucleated giant cells, and scant metachromatic extracellular matrix material. Cell block sections contained minute tissue fragments with neoplastic spindle cells. Immunohistochemical stains showed the tumor cells to be positive for vimentin and negative for cytokeratins, TTF-1, calcitonin, synatophysin, chromogranin, and S-100 protein, suggesting a sarcoma; however, the differential diagnosis also included anaplastic thyroid carcinoma and medullary thyroid carcinoma. Tissue biopsy revealed a high-grade spindle cell neoplasm with osteoid production, consistent with osteosarcoma of the thyroid. The patient developed a large pulmonary embolus and superior vena cava syndrome and no further surgical intervention was performed. She died 5 weeks after the initial diagnosis. Upon retrospective review, the cytologic features resemble osteosarcoma in other areas. Although cytologic features on fine-needle aspiration biopsy may suggest a diagnosis of this rare entity, definitive diagnosis should be deferred to histologic examination.
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Affiliation(s)
- Guo-Xia Tong
- Department of Pathology, Columbia University Medical Center, New York, New York 10032, USA
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Abstract
Prostatic spindle cell lesions are diagnostically challenging and encompass a broad array of benign and malignant processes. A subset of these lesions arises only within the prostate and generally represents entities that originate from the prostate epithelium or stroma, such as sclerosing adenosis, sarcomatoid carcinoma, stromal tumors of uncertain malignant potential (STUMP), and stromal sarcoma. Another subset of spindle cell tumors that involve the prostate are also found at other sites and include solitary fibrous tumor, leiomyosarcoma, and neural lesions among others. Finally, tumors may secondarily involve the prostate yet present as primary prostatic processes, as is evident with several cases of gastrointestinal stromal tumors (GIST). The utility of ancillary studies, including immunohistochemistry, is often limited and the main criteria for diagnosis are the morphologic findings by routine H&E stain. This review addresses the various entities that may present as spindle cell tumors within the adult prostate and discusses the functional aspects of the differential diagnosis of these lesions.
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Affiliation(s)
- Donna E Hansel
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA
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