An unusual cause of hematospermia: Primary adenocarcinoma of the seminal vesicle

Abstract

Adenocarcinoma of the seminal vesicles is one of the rare causes of hematospermia. Primary seminal vesicle adenocarcinoma is extremely rare and difficult to diagnose due to frequent invasion of adenocarcinomas of the surrounding organs, especially the prostate. In the present study, a case of a primary seminal vesicle adenocarcinoma will be discussed in the light of the current literature. IntroductionAdenocarcinoma of the seminal vesicles is one of the rare causes of hematospermia. Primary seminal vesicle adenocarcinoma is extremely rare and difficult to diagnose due to frequent invasion of adenocarcinomas of the surrounding organs, especially the prostate. Since it was first defined, 1 primary seminal vesicle adenocarcinoma has been reported in about 50 patients. In the present study, a case of a primary seminal vesicle adenocarcinoma will be discussed in the light of the current literature. Case reportA 57-year-old male was admitted with urinary retention and 3 episodes of hematospermia within the last 6 months. At another centre, transurethral resection of the bladder plus a prostatic urethral biopsy had been performed one month before due to retention; at that time, the pathologic examination revealed high-grade papillary urothelial carcinoma and mixed adenocarcinoma.During the visit at our centre, the rectal examination revealed a hard, palpable mass obstructing the lumen (grade 3/4). The prostate-specific antigen (PSA) level was 6.19 ng/ mL. The serum carcinoembryonic antigen (CEA) and CA19-9 levels were normal; CA125 was 71.5 U/mL (range: 0-20 U/ mL) and CA15-3 was 41.3 U/mL (range: 5-21 U/mL). During the cystoscopy, there were no tumoural lesions; an indentation was observed from the interior and a mass lesion filling the seminal vesicle region was noted on bimanual examination. Paraffin blocks of the earlier operation were re-examined. Tumour cells with a hobnail appearance and transparent cytoplasm showing papillary and glandular structures were observed. Immunohistochemical evaluation demonstrated that CEA and cytokeratin 7 were positive, and PSA and cytokeratin 20 were negative. A magnetic resonance image showed: a 10×15-cm malignant lesion of cystic-necrotic nature with irregular solid components at the base and a widespread hematoma invading the prostate and the seminal vesicle with a clear-cut interphase between the tumour and the bladder (Fig. 1). According to results, the patient was diagnosed with a seminal vesicle adenocarcinoma.A thin-walled cystic formation with an anterior surface of about 8 cm adhering to the bladder and sigmoid colon was noted on exploration. While the cystic formation was being excised from the surrounding tissues, due to perforation of the wall of the cystic formation, about 100 cc of serous fluid was drained. Solid components at the base of the cystic formation were excised as much as possible; however, some residual mass strongly adherent to the bladder base and rectum had to be left behind. Pathologic examination revealed a malignant tumour exhibiting papill...

Primary Seminal Vesicle Adenocarcinoma Presenting as Acute Urinary Retention and Hematuria: A Case Report

“…The prognosis of seminal vesical adenocarcinoma is often poor due to delayed diagnosis and about 94% of the patients die in less than 3 years [6].…”

“…Only tumors without prostatic involvement might be treated with local excision or with vesiculectomy only, this clinical scenario rarely occurs and ejaculatory canals are frequently invaded; therefore, prostatectomy should also be performed. Radiotherapy can be applied as another treatment modality in the presence of postoperative positive surgical borders or residual tumor [9,6].…”

“…Moreover, to confirm that the tumor is completely or essentially localized to the seminal vesicles, PSA, prostate-specific acid phosphatase (PAP), and CEA should be negative. However, increased serum CEA levels can also be observed in rare cases of seminal vesicle adenocarcinoma [6]. Absence of staining of PSA and PAP helps to distinguish seminal vesical adenocarcinoma from prostatic adenocarcinoma [7].…”

Metastatic primary seminal vesicle adenocarcinoma: management of a rare tumour with multiagent chemotherapy and hormonal therapy

“…It has also been discovered incidentally in the prostates resected for benign prostatic hyperplasia 20. Up to a third of the patients may have a normal rectal examination 7. Cross-sectional imaging like CT or MRI is widely used for evaluating the primary mass, detection of distant metastasis and for anomalies like renal dysgenesis and agenesis 7 21 22.…”

A case of primary adenocarcinoma of the seminal vesicle treated by total laparoscopic pelvic exenteration

“…Er zeigt 19 Monate nach der Operation keine Anzeichen eines Rezidivs. therapy, chemotherapy, and androgen deprivation therapy have been proposed [1,4,6].…”