Solitary fibrous tumour of the prostate

Solitary fibrous tumors of the prostate: A case report

Increasing numbers of extrapleural solitary fibrous tumours (SFTs), including the prostate SFT, have been reported over the last 10-years. Prostate SFT is relatively uncommon, with <20 cases reported in the literature worldwide. In the present study, a prostate SFT case, which was initially misdiagnosed as benign prostatic hyperplasia, is presented. The patient was subjected to three surgeries (cystoscopy and per urethra lithocystotomy, transurethral resection of the prostate and nerve-sparing retropubic radical prostatectomy) prior to SFT diagnosis. It was demonstrated that histopathological and immunohistochemical factors (positive staining for CD34 and B cell lyphoma-2 expression) were of significant diagnostic value. Thus, nerve-sparing retropubic radical prostatectomy for total resection may be the best therapeutic strategy to treat prostate SFT, allowing the preservation of sexual function and reducing the risk of locoregional recurrence.

Complex cellular composition of solitary fibrous tumor of the prostate

Solitary fibrous tumors (SFTs) of the prostate are a rare type of spindle cell neoplasm that can demonstrate either a benign or malignant phenotype. SFTs represent a clinical challenge along with other spindle cell lesions of the prostate in terms of both diagnosis and treatment. The present study shows, for the first time, that SFTs of the prostate and other organs can comprise a mixed population of fibroblast, myofibroblast, and smooth muscle cell types. The highly proliferative component demonstrated a fibroblastic phenotype that readily underwent myofibroblast differentiation on exposure to profibrotic stimuli. Consistent with other recent studies, the prostatic SFTs demonstrated NAB2-STAT6 gene fusions that were also present in the fibroblast, myofibroblast, and smooth muscle cell types of the SFT. The results of these studies suggest that benign and malignant prostatic tumors of mesenchymal origin may be distinguished at the molecular and cellular levels, and that delineation of such defining characteristics may help elucidate the etiology and prognosis of such tumors.

Soft tissue tumors of the anorectum: rare, complex and misunderstood

Anorectal soft tissue tumors are uncommon and often present both diagnostic and therapeutic challenges. Although many of these tumors are identified with imaging performed for unrelated reasons, most present with nonspecific symptoms that can lead to a delay in diagnosis. Historically, radical surgery (abdominoperineal resection) has been the mainstay of treatment for both benign and malignant anorectal soft tissue tumors. However, a lack of proven benefit in benign disease along with changes in technology has called this practice into question. In addition, the role of radiation and/or chemotherapy remains controversial. In this manuscript, we review the history and current status of anorectal soft tissue tumor management, with a particular focus on challenges in optimizing survival.

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.

Solitary fibrous tumor of the prostate: case report and review of the literature

Solitary fibrous tumor (SFT), usually described in the pleura, is exceedingly rare in the prostate. We report a 60-year-old man with prostatic SFT revealed by obstructive urinary symptoms, and detected by ultrasonography. Computed tomography (CT) and magnetic resonance imaging suggested a prostatic origin. CT-guided tumor biopsy diagnosed a SFT. A cystoprostatectomy was performed. Pathologic examination showed a 15-cm tumor arising from the prostate and showing histological criteria suggestive of aggressiveness. The surgical resection margins were tumor-free. The patient was then regularly monitored and is still alive in complete remission, 28 months after surgery. In conclusion, we report a new exceptional case of prostatic SFT. We review the literature and discuss the challenging issues of misdiagnosis, prognosis and treatment.

Radiologic-pathologic findings of solitary fibrous tumor of the prostate presenting as a large mass with delayed filling-in on MRI

We report a case of a solitary fibrous tumor of prostate presenting with urinary retention and a large prostate mass. We describe the clinical presentation, magnetic resonance imaging findings, and histopathology of this rare, benign tumor. Although clinical and radiologic appearances embrace various differential diagnoses including sarcoma, this mass was confirmed by histologic analysis following surgical resection. We report this rare, benign tumor to help the radiologist suggest the diagnosis when presented with a similar case.

Computed tomography and magnetic resonance imaging findings of solitary fibrous tumors in the pelvis: correlation with histopathological findings

OBJECTIVE

We aimed to analyze the computed tomography (CT) and magnetic resonance imaging (MRI) findings of pelvic solitary fibrous tumors (SFTs) and to improve the diagnostic efficacy for such tumors.

METHODS

Six cases of pelvic SFTs confirmed by histopathology were analyzed retrospectively. Of the 6 patients, 4 had undergone CT scanning, and 2 had undergone magnetic resonance imaging. All the patients had undergone unenhanced and contrast-enhanced examinations, and 2 had also undergone dynamic CT enhancement examination. Image characteristics such as shape, size, number, edge, attenuation or intensity for each lesion before and after contrast enhancement were analyzed and compared with the pathomorphology of the tumors.

RESULTS

All the 6 cases showed oval or rounded and well-defined masses. Unenhanced CT images showed heterogeneous masses with patchy, necrotic foci in 3 cases and homogeneous mass in 1 case. None of the tumors showed calcification. Contrast-enhanced CT images showed marked, heterogeneous enhancement in the first and second cases. Dynamic enhancement scan demonstrated mild homogeneous enhancement in the third case and mild prolonged, delayed enhancement and washout in the fourth case. T1-weighted MR images showed heterogeneous mild hypointense lesion with linear hyperintensity in 1 case, and homogeneous isointensity in the other. T2-weighted images showed heterogeneous mixed intensity in 1 case and mostly hyperintensive lesion with hypointense foci in another case. A case showed marked heterogeneous enhancement and another showed marked homogeneous enhancement on contrast-enhanced T1-weighted images.

CONCLUSION

Radiological findings of pelvic SFTs are variable and nonspecific. However, a well-defined, ovoid or rounded mass with hypointense on MR T2-weighted images and variable enhancement on CT and MR images may suggest the diagnosis of SFTs. Pelvic SFTs should be included in the differential diagnosis of regional tumors.

Solitary fibrous tumor of the male pelvis: findings at CT with histopathologic correlation

We present CT imaging findings with pathologic correlation in a rare case of a solitary fibrous tumor arising in the pelvis in a 34-year-old man. This tumor presented as a hypervascular heterogeneously enhancing deep pelvic mass at CT. Although CT initially suggested the prostate as the site of origin for this tumor, no prostate involvement was found at surgery; CT accurately excluded bladder and rectal involvement.

Mesenchymal Tumors of the Prostate

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.

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.

Spindle cell lesions of the adult prostate

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.

Imaging findings of solitary fibrous tumor of the prostate: a case report

The imaging findings of a solitary fibrous tumor of the prostate are presented. A 35-year-old male presented with urinary retention and was found on transrectal ultrasonography to have a hypoechoic tumor of the prostate, measuring 5.5 cm in size. Magnetic resonance imaging on, the tumor showed low signal intensity on T1-weighted images and heterogeneous mixed signal intensity on T2-weighted images. Gadolinium-enhanced dynamic study showed gradual enhancement from the periphery to the center, and the enhancement is sustained. On immunohistochemistry, the spindle cells of the tumor showed positive staining for CD34 and bcl-2. Although the tumor was labeled as a low-grade malignancy on account of a low mitotic index (MIB-1 index) of about 5%, the patient developed local recurrence of the tumor with bladder wall invasion 12 months later.

Tumor fibroso solitario de la próstata

We report a new case of a solitary fibrous tumor. It is a tumor which involve to genitourinary system unusual time, and it is exceptional in the prostate. Our patient began with bladder compression symptoms. Radiological studies showed polilobed mass that moved out the bladder although the could not show the pelvic organ was involved. The definitive diagnosis was made by histology and inmunohistochemestry of the surgical piece.

Prostatite granulomateuse (à propos de 6 cas)

A retrospectively series of six patients with non-specific granulomatous prostatitis is reported. The diagnosis was revealed by the histological examination trans-urethral resection or enucleated prostatique. Only histological examination is able to established the definitive diagnosis. This study and a review of literature permitted us to notice the various epidemiological, clinical, histological of this affection.

Solitary fibrous tumor of the prostate

An extremely rare case of solitary fibrous tumor of the prostate is presented. The patient underwent a radical retropubic prostatectomy and has remained well with no evidence of recurrence during the last 18 months. This is the fifth reported case of such a lesion arising in the prostate.

Solitary fibrous tumor of the prostate a report of 2 cases and review of the literature

We report 2 cases of solitary fibrous tumor of the prostate. Histologically, both tumors demonstrated a multipatterned architecture with varying degrees of collagenization and hemangiopericytoma-like foci, and both were composed of CD34-immunopositive spindled cells that insinuated themselves between strips of collagen. The tumor in case 1 was well circumscribed and showed minimal mitotic activity or pleomorphism, whereas the tumor in case 2 was more cellular, less collagenous, had a more diffuse growth pattern, and exhibited cytologic atypia and high mitotic activity. Prostatic solitary fibrous tumor must be distinguished from other spindle cell tumors reported to occur in the prostate. To our knowledge, these cases represent only the fifth and sixth reported cases of prostatic solitary fibrous tumor.

Solitary fibrous tumor of the lower urogenital tract: a report of five cases involving the seminal vesicles, urinary bladder, and prostate

Solitary fibrous tumor (SFT) is not as site-restricted as once believed. Initially described as a tumor of the pleura, SFT is now recognized at various extrathoracic sites. We report 5 cases of extrapleural SFT involving the male lower urogenital tract. The tumors involved the seminal vesicles (2 cases), urinary bladder (2 cases), and the prostate (1 case). The patients with bladder tumors were asymptomatic. The patients with seminal vesicle involvement presented with hematuria or groin pain. The patient with prostate involvement presented with urinary retention. The prostate tumor was large, and it could not be completely excised because of its extensive spread beyond the prostate into the pelvis. The other 4 tumors were completely excised, and none has recurred during limited follow-up. By histological criteria, 4 of the tumors were benign, and 1 was malignant. Even though the classic histological features of SFT were well developed in each case, all 5 tumors were initially misdiagnosed, including 3 benign tumors that were misclassified as sarcomas. These 5 cases confirm the male lower genitourinary tract as yet another site of origin for SFTs, challenge the notion that extrapleural SFTs invariably are benign, and draw attention to the problem of recognizing SFTs when they arise in unexpected sites.