Prostatic Cystadenoma Research Articles

Complete resolution of a giant multilocular prostatic cystadenoma following androgen deprivation therapy: an illustrative case report

ABSTRACTGiant multilocular prostatic cystadenoma (GMPC) is a rare benign pelvic mass for which complete surgical resection is an accepted treatment of choice. This report presents the first case of complete resolution of GMPC following a 3-year course of luteinising hormone-releasing hormone agonist alongside external beam radiotherapy for the concurrent treatment of unfavorable intermediate-risk prostate cancer. In addition to illustrating the imaging features of the effect of androgen deprivation therapy (ADT) and radiotherapy on GMPC regression, this case provides evidence for considering ADT as an alternative, noninvasive GMPC treatment option in patients in whom surgical treatment is either contraindicated or can be made less invasive by reducing the size of GMPC prior to its removal.

Giant multilocular prostatic cystadenoma

BackgroundThe giant multilocular prostatic cystadenoma is a very rare benign tumor of the prostate gland. It is composed of predominantly cystic enlarged prostatic glands in a fibrous stroma and spreads extensively into the pelvis. Because of the large size at the time of diagnosis, it is not always possible to determine the exact point of origin for these multilocular cystic neoplasms. Thus, diagnosis before histological examination of a surgical specimen is often difficult. Here, we present a case involving one of the largest giant multilocular prostatic cystadenomas reported in the literature and discuss preoperative diagnoses and appropriate surgical approaches for this rare retroperitoneal tumor.Case presentationA 50-year-old man presented with a 2-year history of abdominal distension and lower urinary symptoms. Enhanced CT showed a large retroperitoneal mass with multiple septations in the pelvis and lower abdomen, measuring 30 cm in size, surrounding the rectum and displacing the bladder, prostate, and seminal vesicle to the right anterior side. MRI showed multiple cysts with a simple fluid appearance on T2-weighted images and enhanced solid components on gadolinium-enhanced fat-saturated T1-weighted images, suggesting the retroperitoneal mass as leiomyoma with cystic degeneration or perivascular epithelioid cell tumor. Biopsy of the mass showed a spindle cell tumor with focal smooth muscle differentiation. Differential diagnosis comprising leiomyoma, low-grade leiomyosarcoma, and perivascular epithelioid cell tumor was made. Complete resection of the tumor with low anterior resection of the rectum was performed. The tumor was solid with multilocular cavities containing blackish-brown fluid and measured 33 × 23 × 10 cm. Histologically, the tumor was composed of variously sized dilated glandular structures lined by prostatic epithelia surrounded by fibromuscular stroma. The prostatic nature of the lesions was confirmed by immunohistochemical staining of the epithelium for prostate-specific antigen. Thus, pathological diagnosis was a giant multilocular prostatic cystadenoma.ConclusionsWe present our experiences with one of the largest giant multilocular prostatic cystadenomas. When a retroperitoneal huge lesion with locular cavities fills the pelvis in a male patient, the possibility of giant multilocular prostatic cystadenoma should be considered before planning for retroperitoneal tumor treatment.

Does Giant Multilocular Cystadenoma of Prostate Respond to LHRH Agonist or It Is a Case of Cystic Prostate Cancer Wrongly Diagnosed– A Report of 3 Cases and Review of Literature

A retrospective review of radiology registry identified 3 cases of diagnosed giant multilocular cystadenoma of prostate. The first case illustrates a 59-year-old man with worsening voiding and storage symptoms of 2 months duration. The prostate was enlarged with the right lobe being bigger than the left node and his PSA was 9.3 ug/l. MRI showed large Multi cystic mass from the prostate and TRUS biopsy revealed adenocarcinoma prostate. Neoadjuvant LHRH agonist shrunk the mass before radiotherapy. He has no urinary symptoms and PSA consistently less than 0.1. Repeat MRI showed highly shrunken mass. In the second case, we present a 79-year-old patient presenting with rising PSA despite being on finasteride. MRI diagnosed large cystic and solid mass arising from the prostate and extending to the abdomen. Tran’s rectal ultrasound guided biopsy plus aspiration of the fluid from the multiloculated cyst revealed benign cystic adenoma with no evidence of any malignancy. Repeat MRI after 6 months of LHRH agonist showed multiloculated cyst adenoma of the prostate appears stable with no significant reduction in size and his PSA remains high. The third case is an 83-year-old presenting with LUTS, haematuria and rising PSA. He has a past medical history of low grade prostate cancer (diagnosed at TURP). MRI scan showed an enlarged echogenic prostate. TRUS biopsy of the mass identified complex proliferation of atypical glandular epithelium in a rather villous adenomatous pattern. Neoadjuvant LHRH agonist showed reduction in lower urinary symptoms.

Prostatic Masses in Geldings: Two Cases

Prostatic masses were detected in two geldings that were presented to our referral hospital for evaluation of dysuria. The masses were detected during transrectal palpation and ultrasonography of the prostate gland and were further evaluated using urethral endoscopy. A 10-year-old gelding underwent intraurethral debulking of the prostatic mass. Histopathological diagnosis was prostatic cystadenoma. The mass regrew within 9 months, and the horse was euthanized due to deteriorating clinical control of urinary continence. In another case, a 12-year-old gelding was scheduled for transurethral debulking; however, the owners decided against treatment and the horse was euthanized due to progression of clinical disease. Postmortem examination revealed the prostate to be nearly completely obliterated by the mass. Histopathological diagnosis was adenocarcinoma incorporated into a spindle cell population of unknown histogenesis. To our knowledge, these represent the first reported cases of equine prostatic cystadenoma and adenocarcinoma. In both horses, referring complaint was dysuria, and identification of the prostatic mass was made on palpation and ultrasonographic examination per rectum. Treatment options for prostatic masses in horses are limited because of the difficulty of obtaining prostatic tissue via biopsy, the surgical inaccessibility of the gland, and the apparent low incidence of occurrence. We have subsequently identified prostatic masses in two additional geldings, both also presenting for dysuria. However, the exact nature of these two apparent prostatic masses has not been definitively diagnosed with histopathological examinations to date. The prostate should be evaluated in male horses presenting for dysuria.

Giant Multilocular Cystadenoma of the Prostate: A Rare Cause of Huge Cystic Pelvic Mass

Giant multilocular prostatic cystadenoma is a rare benign tumor that evolves from the prostate gland. Obstructive voiding symptoms occur in all reported cases. These lesions do not invade adjacent structures. Preoperative radiologic evaluation can define the benign nature of the lesion. Here we report a case of large cystic lesions identified by magnetic resonance imaging and sonographic findings that caused an extensive mass effect in the pelvis. When retrovesical, huge cystic lesions fill the pelvis completely in young men, with high levels of serum prostate-specific antigen, giant multilocular prostatic cystadenoma should be considered as a differential diagnosis. To our knowledge, this is the youngest case of prostatic cystadenoma reported in the literature.

Prostate Cystadenoma Presenting With Obstructive Azoospermia

We report on a case of prostate multilocular cystadenoma presenting with primary infertility and obstructive azoospermia. Our patient is a 36-year-old presenting with primary infertility in addition to mild deep pelvic pain. Semen analysis revealed azoospermia with positive fructose. His prostate-specific antigen was 0.7 ng/dL and his imaging revealed a large multilocular cystic mass with multiple internal enhancing septa. Transrectal ultrasonography-guided aspiration and biopsies revealed a lining of regular low cuboidal cells. Surgical removal was undertaken through a transperitoneal/retroperitoneal approach and pathology was consistent with a prostatic multilocular cystadenoma. Further studies are needed to characterize and classify cystic lesions of the prostate.

Conventional prostatic adenocarcinoma arising in a multilocular prostatic cystadenoma

Multilocular prostatic cystadenoma is a rare benign neoplasm located between the bladder and the rectum. These are prostatic tissue and have been shown to harbor high-grade intraepithelial neoplasia and likely susceptible to the same disease processes seen in the prostate gland. We report the first case of conventional prostatic adenocarcinoma involving a multilocular cystadenoma. Distinction from cystadenocarcinoma is also made.

Retrovesical Multilocular Prostatic Cystadenoma Mimicking a Pelvic Cavity Tumor

We report the case of a 58-year-old man with a multilocular prostatic cystadenoma in the retrovesical space that mimicked a pelvic cavity tumor. Multilocular prostatic cystadenoma is a rare form of benign prostatic hyperplasia that originates from the prostate with extensive spread into the pelvis. Histologically, the tumor consisted of glands and cysts lined by prostatic-type epithelium lying in a hypocellular fibrous stroma. For a cystic tumor adjacent to the urinary tract, ectopic prostatic cystadenoma is needed to be considered in the differential diagnosis of pelvic cavity tumors.

Giant Multilocular Prostatic Cystadenoma In A 15-Year Old: Radical Surgery Not Necessary

Giant multilocular prostatic cystadenoma is a rare benign tumour of the prostate, with approximately 19 reported cases in the world. We present the youngest reported case.A 15-year-old male presented to the emergency department with lower abdominal pain and urinary retention. Abdominal examination revealed a tender and palpable bladder. CT scan showed a multiseptated cystic mass in the recto-vesical region, and a laparotomy was performed to remove the mass. The tumour measured 11x9x5cm, and consisted of multi-loculated cysts filled with clear and haemorrhagic fluid. Microscopically, the glands were lined by benign prostatic-type epithelium with cystic dilatation. A diagnosis of giant multilocular prostatic cystadenoma was made. At 2-month follow-up, a residual tumour was identified on a CT scan; however, unlike previously reported cases; this tumour regressed in size at 10-month follow-up without active interventions. We believe radical surgery is not necessary to manage this tumour as previously recommended.

Giant Multilocular Prostatic Cystadenoma Presenting with Obstructive Aspermia

Giant multilocular prostatic cystadenoma (GMPC) is a rare benign tumor involving the prostate gland. Microscopically, it masquerades phyllodes tumor or transitional zone hyperplasia. We report one case of GMPC arising from the prostate central zone (CZ), presenting with long-standing aspermia associated with seminal vesicle fibrous obliteration.

Multilocular cystadenoma and cystadenocarcinoma of the prostate

Background Multicystic prostatic tumors are rare, with only a few reported cases of prostatic cystadenoma and cystadenocarcinoma in the scientific literature. Methods A retrospective review of our tumor registry over the last 25 years identified 2 rare cystic tumors of the prostate: 1 multilocular cystadenoma and 1 multilocular cystadenocarcinoma. Results The first case illustrates the clinical and pathologic features of prostatic multilocular cystadenoma. A 42-year-old man presented with a 16-cm suprapubic mass causing displacement of adjacent visceral organs. Pathologic examination after prostatectomy confirmed it to be a multilocular cystadenoma of the prostate. The patient’s postoperative course was uneventful, and his serum prostate-specific antigen level remained at ≤0.04 ng/ml throughout the course of his disease. In the second case, we present an 80-year-old male presenting with a 12-cm cystic mass of the prostate. His serum prostate-specific antigen level remained at ≥9.0 ng/ml throughout the course of his disease. The tumor had an aggressive local growth pattern, with invasion into perirectal adipose tissue. This patient underwent a pelvic exenteration, followed by adjuvant systemic chemotherapy and complete androgen blockade. Despite aggressive treatment, he had 3 recurrences over 4 months but remains alive with disease at 23-month follow-up. Conclusions Cystadenocarcinoma of the prostate is locally aggressive and should be included in the differential diagnosis of cystic lesions of the prostate.

Giant Multilocular Prostatic Cystadenoma

Benign prostatic cystadenoma is a well-known distinct clinicopathologic entity. It is uncommon for these benign cystic lesions to become symptomatic, unless they are large enough to impinge on the adjacent viscera. Large multilocular cysts and cystic neoplasms of the prostate are rare, with only a few reported cases in the literature. Giant multilocular prostatic cystadenoma, initially described by Maluf et al, 1 is a pathologically benign entity It is not always possible to determine the exact point of origin of these multilocular cystic neoplasms because of their large size at the time they are diagnosed. A review of the literature revealed 15 reported cases of multilocular prostatic cystadenoma between 1991 and 2003. We report a rare case of giant multilocular prostatic cystadenoma confirmed by histologic and immunopathologic methods.

前立腺嚢胞性腺腫の一例

We report a case of prostatic cystadenoma. A 81-year-old man visited our hospital with the chief complaint of urinary difficulty. RUG and DIP showed bladder and prostatic urethra deviated to the left side. TRUS, CT and MRI revealed multilocular cyst in the pelvic cavity. Resection of the cystic wall was performed under the diagnosis of pelvic cyst. The cysts were originated from the right side of the prostate and adhered with the bladder severely. The histopathological diagnosis was prostatic cystadenoma. Fortyfive cases of prostatic cyst in the Japanese literature are reviewed.

Multilocular prostatic cystadenoma with high-grade prostatic intraepithelial neoplasia

Multilocular prostatic cystadenoma is a rarely encountered neoplasm located in the midline between the bladder and rectum that is either attached to the prostate by a pedicle or separate from the prostate entirely. Histologically and immunohistochemically these lesions resemble benign prostate tissue. We report the first case of this entity for which multifocal high-grade prostatic intraepithelial neoplasia (PIN) is identified. Conceptually, the finding of high-grade PIN in multilocular prostatic cystadenomas provides further evidence that these lesions are fully analogous to the prostate gland not only in their morphology and immunohistochemistry but also in their predilection for the same diseases.

GIANT MULTILOCULAR PROSTATIC CYSTADENOMA

A 57-year-old man presented with a 1-year history of a lower abdominal mass and dysuria. Excretory urography showed an anteriorly displaced bladder compressed by a large pelvic mass on lateral view. However, examination of the upper urinary tract was normal. Computerized tomography of the abdomen and pelvis revealed a large multiseptated pelvic mass with thickened irregular walls displacing the bladder and rectum. Different attenuations were in each loculus, and there was contrast material enhancement of the internal septa. Magnetic resonance imaging (MRI) of the pelvis demonstrated a large multiseptated pelvic mass with different signal intensities in each loculus, suggesting hemorrhagic or proteinaceous fluid components. Sagittal T1weighted image showed effects of the mass on the bladder and rectum (fig. 1). Exploration of the retroperitoneum revealed a large cystic mass apparently arising in the pelvic floor between the rectum and bladder. The mass was compressing and displacing the bladder anterolaterally and adhering to the bladder wall. The specimen was an approximately 15 3 10 3 8 cm. tan cystic mass weighing 300 gm. with a rough, shaggy surface. Cut section revealed multilocular cysts filled with brown, rusty appearing fluid. In several cysts there was transparent serous fluid. Size varied from minute to several cm. Microscopically, the cysts were lined by double layers of epithelium, reminiscent of prostate tissue (fig. 2). The larger cysts had flattened epithelium. The lining was focally multilayered or squamous metaplasia. The luminal borders of the glands stained positive with periodic acid-Schiff and alcian blue at pH 2.5. The epithelial cells were immunoreactive for prostate specific antigen. The stroma surrounding the glands was hypocellular and focally markedly hyalinized. No atypical feature was noted in the glandular or stromal component of the mass. The pathological findings were consistent with multilocular prostatic cystadenoma.

Giant multilocular cystadenoma of the prostate

Giant multilocular prostatic cystadenoma is a rare clinicopathologic entity characterized by benign histology and the ability to enlarge massively. The lesion may arise from the prostate gland either in continuity with the prostatic urethra or separate from it, or it may arise as a lesion distinct from the prostate gland. Obstructive voiding symptoms occur in all reported cases. The use of preoperative radiographic evaluation, such as magnetic resonance imaging, effectively defines the lesion's benign nature and aids in planning surgical extirpation.

Multilocular Prostatic Cystadenoma Presenting as a Large Complex Pelvic Cystic Mass

Symptomatic prostatic cysts are not common. We report a case of a large complex cystic pelvic mass encountered in a Jordanian man that proved to be a huge midline prostatic cyst with seminal vesicle contained within the wall. This finding represents a variation of the newly proposed diagnosis, multilocular prostatic cystadenoma.

Giant Multilocular Prostatic Cystadenoma

Two examples of large, multiloculated, cystic tumors that arose within the pelvis in men of 28 and 37 years of age are described. The tumors were composed of glands and cysts lined by prostatic-type epithelium lying in a hypocellular fibrous stroma. The prostatic nature of the lesions was confirmed by immunohistochemical staining of the epithelium for prostate-specific antigen and prostatic acid phosphatase. Two apparently similar lesions were found in the literature; one tumor was attached to the prostate by a pedicle, and the other arose in the retrovesical space. These tumors, for which we propose the designation "giant multilocular prostatic cystadenoma," appear to be benign, although they may recur if incompletely excised. They may pose considerable diagnostic difficulty if the prostatic nature of the epithelium is not appreciated, an error that is likely if a relationship to the prostate is not recognized. This lesion should be included in the differential diagnosis of retroperitoneal cystic tumors in men.