Primary Rhabdomyosarcoma of the Seminal Vesicle

Abstract

CASE REPORT A 50-year-old man was evaluated for transient tetraplegia. Digital rectal examination revealed a hard palpable mass not directly in contact with the prostate. Sonography showed the right seminal vesicle as the tissue of origin of the spherical tumor (fig. 1). Computerized tomography demonstrated a round 8 8 cm. contrast enhancing solid mass situated between the rectum and bladder without evidence of metastasis (fig. 2). Prostate specific antigen was 0.3 ng./ml. The tumor of the right seminal vesicle was resected, and because of infiltration of the lateral bladder wall, partial resection of the bladder was performed. However, tumor resection was complete. Frozen section revealed a histopathological diagnosis of sarcoma, but the pathologist could not make a definitive diagnosis. Therefore, intraoperative radiation (12 Gy.) was performed. The final histopathological evaluation, including immunohistochemistry, showed a high grade embryonic rhabdomyosarcoma with noticeable nuclear polymorphisms and expression of myoglobin, actin, myosin and desmin. Postoperatively external beam radiation therapy was performed with an overall dose of 50.4 Gy. (28 times 1.8 Gy. single dose). While on radiation therapy, the patient also received chemotherapy consisting of 2,820 mg. ifosfamide and 94 mg. doxorubicin. Followup comprising magnetic resonance imaging and physical examination was performed quarterly during the first year and semiannually from the second year onward. At 19 months postoperatively the patient presented with painless gross hematuria, but cystoscopy and biopsy demonstrated no malignancy. At 35 months postoperatively the patient was disease-free. Twenty months after completion of radiation therapy hydronephrosis developed as a long-term sequela on the right side.