Importance of an Early Diagnosis in Primary Adenocarcinoma of the Seminal Vesicle

Abstract

The prognosis of seminal vesicle (SV) adenocarcinoma is often poor due to delayed diagnosis. About 95% of the patients die in less than 3 years. Diagnosis is difficult due to the absence of early clinical signs as hematuria, hematospermia and/or dysuria. We present the case of a 61-year-old Caucasian man with a left SV mass detected by transrectal ultrasound. SV ultrasound-guided biopsy showed an adenocarcinoma. The tumor was uniformly strongly immunoreactive for cytokeratin-7 and carcinoembryonic antigen. There was no immunoreactivity for prostate-specific acid phosphatase (PSAP) and CK-20. These tumors have been reported to be also positive for CA-125. Therefore a combination of positive staining for CK-7, CEA and CA-125; with negative staining for CK-20, PSA and PSAP is the pattern of immunohistochemical findings noted for this rare tumor. The computed tomography of the abdomen-pelvis and chest X-ray was negative for metastases. The patient underwent a radical prostatectomy and lymphadenectomy. The prostate, rectum, bladder and lymph nodes were free from tumor involvement. The patient did not receive any adjuvant chemotherapy or radiation; and remains free of disease 3 years post-surgery.

Primary Adenocarcinoma of the Seminal Vesicle

“…Diagnostic difficulties include the absence of symptoms at an early stage and the lack of well-defined diagnostic criteria. 5 , 6 Symptoms in most cases are not specific, commonly: hematuria, hematospermia, pelvic/perineal pain and dysuria.…”

Primary seminal vesicle adenocarcinoma: a lethal yet cryptic malignancy with review of literature

“…Secondary neoplastic involvement of seminal vesicle is more frequent as compared with PSVA. Diagnosis is unlikely at an early stage due to the absence of symptoms and when the patients become symptomatic, they often suggest locally advanced disease masking the seminal vesicular origin of the tumour 3 5 6. It has been suggested that agenesis or dysgenesis of the kidneys with ectopic ureters exposes the epithelium of the seminal vesicles to carcinogens which could lead to PSVA in one or both the glands 7…”