Every TURP Is not Just BPH

Abstract

Abstract Introduction/Objective Transurethral resection of prostate is a common specimen in surgical pathology practice. These specimens usually demonstrate benign prostatic hyperplasia. However, occasionally incidental prostate cancer is identified. Finding a true mesenchymal tumor in these specimens is exceedingly rare. We present a unique case of prostatic adenocarcinoma Gleason score 3 + 4 =7 and concurrent solitary fibrous tumor identified on a TURP specimen. Solitary fibrous tumor in this anatomical location is rare with approximately 50 cases reported in the English language literature. Methods/Case Report An 86-year-old male presented with symptoms and signs of urinary retention. On clinical evaluation the prostatae was profoundly enlarged with a calculated volume of 283cc; firm in consistency. He was given trial of medical management including finasteride, tamsulosin and Foley catheter placement. Subsequently, the patient underwent transurethral resection of prostate. Complete morcellation was not possible at the initial surgery due to hard consistency of the gland. Pathologic evaluation showed prostatic adenocarcinoma Gleason grade 3 + 4=Score 7 (Grade group 2) involving 10% of submitted tissue in addition to the changes of benign prostatic hyperplasia. Additionally, the background stroma demonstrated short plump oval to spindle cells with inconspicuous nucleoli and collagenous background, arranged in a haphazard (‘‘patternless’’) pattern. Immunohistochemical stains showed these lesional cells to be positive for STAT6 and CD34 and negative for desmin, S100, SOX-10, CD 117, DOG-1 and NKX 3.1. Morphology and immunohistochemical profile were compatible with solitary fibrous tumor involving the prostate. The patient is alive and symptom-free 9 months after the procedure. Results (if a Case Study enter NA) NA. Conclusion This case highlights the value of thorough evaluation of prostatic tissue in TURP specimens not only for prostate cancer but other tumors as well. It also reminds the practising pathologist to keep an eye out for the stromal lesions of the prostate gland. Also finding one lesion should not dissuade one from looking for additional concurrent lesions.