A case of malignant lymphoma of the prostate

We report a case of primary malignant lymphoma of the prostate. A 76-year-old man was refer to our clinic with a chief complaint of dysuria. Based on a benign prostatic hypertrophy, transurethral resection of the prostate was performed. Histological findings showed diffuse, large cell type malignant lymphoma. His clinical stage was 1 A prostate (+) according to the Ann Abor classification. The combination chemotherapy with THP-COP was performed for 3 courses, followed by irradiation at 30 Gy. His prostate has showed no recurrence for 10 month after treatment. Primary malignant lymphoma of the prostate is rare. About 30 cases have been reported in the japanese literature. Preoperative diagnosis of malignant lymphoma of the prostate is difficult. All cases have been diagnosed after prostatic surgery or biopsy.     

T-cell Lymphocytic Lymphoma Involving the Prostate Presenting as Elevated PSA in Paraplegia: Case Report

abstract

The vast majority of cancers that involve the prostate are adenocarcinomas of the duct-acinar secretory epithelium. Other cancers, primarily leukemia and lymphoma, can involve the prostate and lead to an abnormal digital examination or elevated serum prostate specific antigen (PSA). The case discussed is that of a 62 year-old male with T12 complete paraplegia who presented with a persistently elevated PSA and was subsequently diagnosed with T-cell lymphoma involving the prostate. Although rare, leukemia and lymphoma involving the prostate should be included in the differential diagnosis of patients being evaluated for adenocarcinoma of the prostate. (J Spinal Cord Med, 19:258–260)     

Malignant lymphoma of the prostate: a case report]

A case of a primary malignant lymphoma of the prostate is presented. An 82-year-old man visited our hospital complaining of anal pain. Digital rectal examination revealed an enlarged prostate gland, which caused a rectal stricture. A computed tomographic scan and magnetic resonance imaging (MRI) showed a large mass arising from the prostate and protruding to the rectum. According to the Working Formulation, he was diagnosed with non-Hodgkin's lymphoma of B-cell origin, diffuse, mixed, small and large cell. The results of bone marrow puncture and imaging studies led to the diagnosis of primary malignant lymphoma of the prostate. Because of poor performance status deriving from severe anal pain, radiation therapy was performed to control the pain. After improvement of his performance status, he received combination chemotherapy consisting of cyclophosphamide, adriamycin, vincristine and predonisone (CHOP regimen). His prostate markedly diminished in size, but pneumonia developed. His respiratory condition rapidly deteriorated, and he died of respiratory failure about two and a half months after the onset of his illness. Malignant lymphoma involving the prostate, whether primary or secondary, is very rare. In our understanding, this case is thought to be the 28th clinical case of a malignant lymphoma of the prostate in Japan.     

Incidental and concurrent malignant lymphomas discovered at the time of prostatectomy and prostate biopsy: a study of 29 cases

The incidence and histologic features of malignant lymphomas discovered at the time of prostate biopsy, transurethral resection, and prostatectomy are not well documented. We searched our surgical pathology files for malignant lymphomas identified from prostate surgical specimens from 1989 to 2004. Of 4,831 cases of prostate specimens (3,405 biopsies, 266 transurethral resections, 1,160 prostatectomies) examined at the City of Hope during this period, 29 cases of malignant lymphomas involving the prostate and pelvic lymph nodes were identified (0.6%). These malignant lymphomas can be divided into two groups: 1) 18 incidental cases (0.37%) without prior history of malignant lymphoma; and 2) 11 cases (0.23%) with concurrent known malignant lymphoma. For the first group, the patients with pelvic node involvement ranged in age from 59 to 78 years (mean, 69.2 years; median, 70 years), and the patients with prostate involvement ranged in age from 45 to 78 years (mean, 64.6 years; median, 67.5 years). For the second group, the patients ranged in age from 53 to 80 years (mean, 66.8 years; median, 69 years). Diagnoses of all cases were confirmed by immunohistochemistry or molecular analysis. Ten of 18 cases in the first group involved pelvic nodes only, and the other 8 cases were primary prostatic lymphoma. Of 18 cases in the first group, 13 were small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL), 3 were marginal zone B-cell lymphoma, and 1 was mantle cell lymphoma. These lymphomas were not readily apparent in most cases by histologic examination, and may be confused with chronic prostatitis when the prostate was involved or with reactive lymphoid hyperplasia when pelvic nodes were involved. Immunohistochemistry and molecular studies may be necessary to confirm the diagnosis. For the second group, prostate and pelvic lymph nodes were involved as part of systemic dissemination of concurrent malignant lymphoma. The diagnosis was usually easily established in these cases. Of 11 cases, 4 were SLL/CLL, 4 were follicular lymphoma, 2 were mantle cell lymphoma, and 1 was diffuse large B-cell lymphoma.     

Primary lymphoma of prostate: transrectal ultrasonic appearance

In the case presented, primary lymphoma of the prostate was diagnosed by ultrasonically guided transrectal biopsy. Primary lymphoma of the prostate should be included in the differential diagnosis of a hypoechoic lesion found on ultrasonic evaluation of the prostate in a young adult.     

Secondary prostatic lymphoma in a kidney transplant patient

Lymphoma involving the prostate is rare, both as a primary and as a secondary presenting. Usually the prognosis remains poor. The clinical presentation is similar to that of other lower urinary tract obstructions, in fact prostatic lymphoma must be considered in patients with these symptoms, particularly in patients with prior history of systemic lymphoma. We report a case of a kidney transplantation in a male patient, diagnosis of lymphoma non Hodgkin, with later recurrence in prostate.     

Prostatic carcinoma with concomitant non-Hodgkin lymphoma. Report of 2 cases

We report 2 cases of adenocarcinoma of the prostate with concomitant non-Hodgkin lymphoma. Only 9 cases of this rare combination have been reported. Both cases are responding well to treatment. The 1st case is 17 years since the diagnosis of adenocarcinoma of prostate and 6 years since the appearance of the lymphoma. The 2nd case is 1 year after being operated on for a gastric lymphoma and 7 months since the diagnosis of adenocarcinoma of prostate was made.     

Primary lymphoma of the prostate: report of a clinico-pathological case and review of the literature

Lymphoma involving the prostate is rare, wether presenting as primary extranodal lymphoma or as a secondary spread to the prostate from other sites. There are less than 100 cases reported in the literature and accounts for 0.09-0.1%. The clinical presentation can be attributed to nodular hyperplasia or prostatic carcinoma. Criteria for primary prostatic lymphoma include: 1) tumor limited to the prostate and adjacent soft tissues. 2) the absence of lymph node involvement. 3) a lymphoma free interval of at least 1 month. The evolution is rapid and the prognosis remains poor regardless of the patient age, histologic type, treatment, or clinical stage of disease at presentation. We report a case of a 65 years old male in which the incidental diagnosis of lymphoma of the prostate was performed in the adenomectomy. The clinico-pathological criteria and the histogenesis of this entity are described.     

Non-Hodgkin lymphoma arising in lower urinary tract

Primary involvement of the bladder and prostate by non-Hodgkin lymphoma is exceedingly rare. Usually bladder lymphoma can be cured by aggressive local therapy, but the prognosis of prostatic lymphoma is poor. The devastating clinical course of a young man with primary lymphoma involving the prostate and bladder base is reported to emphasize the heterogeneity of this group of tumors and to encourage precise tumor classification. Prognosis depends on the tumor stage and the specific lymphoma cell-type as defined by conventional histologic and immunologic criteria. Management should be tailored according to tumor grade, stage, and site.     

Primary lymphoma of the prostate: a rare cause of urinary obstruction

Primary lymphoma of the prostate is rare. It represents 0.09% of prostate neoplasias. The authors report the case of a 42-year old patient presenting urinary obstruction and renal failure due to primary lymphoma of the prostate. We discuss the clinical manifestations of this disease, emphasizing that systemic chemotherapy represents the initial and preferential therapeutic method.     

Primary non-Hodgkin lymphoma of prostate

Since 1877, 42 cases of non-Hodgkin lymphoma of the prostate have been reported in the medical literature, whereby the occurrence of a primary process could only be assumed in a very few of these. We report a case of primary non-Hodgkin lymphoma of the prostate, including a review of literature, and point out the difficulties involved in diagnosing such cases.     

Primary lymphoma of prostate presenting as bladder outflow obstruction

We report on a patient with prostatic lymphoma who presented with symptoms of bladder neck obstruction. Biopsy specimens from transurethral resection confirmed the diagnosis of prostatic lymphoma. There was no evidence of lymphoma spread. Treatment was by local x-ray therapy to the prostate gland. Since prostatic lymphoma is rare, the clinical literature is briefly reviewed.     

Primary malignant lymphoma of the prostate: report of a case achieving complete response to combination chemotherapy and review of 22 Japanese cases

A 70-year-old man presented with complaints of difficult urination, perineal pain and lassitude. An enlarged, hard and nodular prostate was palpable on digital rectal examination. Needle biopsy of the prostate was performed, which revealed diffuse large B-cell non-Hodgkin's lymphoma by immunohistochemical studies. Right internal and external iliac nodes were swollen on computed tomographic scan (CT) of the pelvis. No abnormal finding was seen on abdominal CT, upper gastrointestinal fiberscopy and bone marrow histology. Therefore, the disease was classified into the clinical stage II according to Ann Arbor's criteria. The patient achieved complete response (CR) to five cycles of combination chemotherapy, CHOP, and survives more than two years without recurrence. Primary malignant lymphoma of the prostate is a rare prostatic malignancy. Only 22 Japanese cases with primary prostatic lymphoma have been reported to our knowledge. In 23 cases including ours the majority of the patients were older than 60 years, and their histopathology was mostly diffuse lymphoma, which belongs to intermediate grade of non-Hodjkin's lymphoma according to the Working Formulation's Classification. Nineteen out of 23 cases (83%) were divided into localized stage i.e. stage I or II. In these reports, three of five cases treated with either radical prostatectomy or radiotherapy alone resulted in death or progressive disease. On the other hand, 11 out of 16 cases (69%) who received chemotherapy alone or with other therapy obtained CR. Primary lymphoma of prostate has previously been considered to have a poor prognosis. Our results, however, suggest that patients with this malignancy respond well to combined chemotherapy, and could possibly be cured when the disease is confined to the localized stage.     

Extra-nodal small cell lymphocytic lymphoma of prostate: an unusual cause of lower urinary tract symptoms

Malignant lymphoma of the prostate is a rare occurrence. We describe a case of 60-year-old man presenting with acute urinary retention due to small cell lymphocytic secondary lymphoma of the prostate. We present the clinical manifestation of the disease emphasizing that all lower urinary tract symptom (LUTS) cases should be evaluated for the potential that metastatic cancers or lymphomas may present with such a diagnosis. We also present and tabulate a detailed review of at least 5 such similar reports (in which LUTS was the presenting symptom) published in the English literature to date.     

Multicentric involvement of non-Hodgkin's lymphoma in the central nervous system and testis--case report

A 73-year-old male presented with diffuse mixed B cell lymphoma with involvement of the central nervous system (CNS) and testis manifesting as mild disorientation and aphasia. A left frontal cerebral mass and a right testicular tumor were found, and both lesions were surgically resected. Histological examination revealed diffuse mixed B cell type malignant lymphoma in the CNS and testis. The patient received irradiation to the head, and his initial symptoms improved. Pelvic computed tomography revealed enlargement of the contralateral testis and prostate. Needle biopsy confirmed lymphoma. The patient died 5 months after the initial diagnosis of septic shock. Autopsy examination revealed lymphoma cell invasion of the lung, bone marrow, prostate gland, and thalamus, but without involvement of the systemic lymph nodes. In a patient with an intracranial lymphoma, it is important to determine if the lesion is primary or metastatic and to plan medical treatment including systemic chemotherapy as soon as possible. Improvement of the prognosis of systemic non-Hodgkin's lymphoma with CNS involvement requires the detection and effective treatment of systemic lesions as well as the control of the CNS lesions.     

Detection of a non-Hodgkin's lymphoma by capromab pendetide scintigraphy (ProstaScint) in a patient with prostate carcinoma

A 77-year-old man with Gleason score 7 prostate cancer, after radical prostatectomy, in whom the prostate-specific antigen level increased to 5.0 ng/mL 8 years later, underwent a ProstaScint scan. Radiotracer deposition was noted in the prostatic "fossa," highly suspicious of recurrence. An additional focus in the mid abdomen was suspicious of adenopathy. Computed tomography disclosed an abdominal mass that, at biopsy, proved to be a malignant B-cell lymphoma. That lesion resolved after chemotherapy, and the prostate-specific antigen level substantially decreased with hormonal treatment. The possible association of prostate cancer and lymphoma is discussed.     

A case of primary malignant lymphoma of the prostate presenting as urinary retention

We report a case of primary malignant lymphoma of the prostate. An 84-year-old man was referred to our hospital with a chief complaint of urinary retention. Magnetic resonance imaging showed a large mass below the bladder and in front of the rectum. Histological and immunocytochemical studies of transperineal biopsy of the prostate showed diffuse large B-cell non-Hogkin's lymphoma. Radiological assessment of the disease confirmed stage IV according to the Ann Arbor classification. Although the tumor was markedly reduced in size after four cycles of combination chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone, he died with brain metastasis 4 months after the diagnosis.     

Le lymphome primitif de la prostate: à propos d’un cas avec revue de la littérature

Primary lymphoma of the prostate is a rare malignancy. Patients initially present with local and general symptoms. A variety of treatments have been used, including prostatectomy, radiotherapy, or a combination of chemotherapy and radiotherapy. Reports in the literature reflect the poor outcome of prostatic lymphoma due to the fact that it is usually diagnosed late. We report the case of a 73-year-old patient who presented with urinary retention associated with persistent constipation and considerable weight loss. He was diabetic and reported a history of transitional cell carcinoma stage pT1, grade G3, which had been treated with transurethral resection and BCG therapy. Physical examination revealed a considerably enlarged prostate which was confirmed by imaging studies. Histological analysis of the tissue obtained on transrectal biopsy revealed a primary malignant non-Hodgkin lymphoma, type B, of the prostate. The patient was treated with chemotherapy. Despite considerable reduction of the tumor size starting from the 3^rd week, the patient died the day after his 5^th course of chemotherapy.     

Primary prostatic involvement in non-Hodgkin lymphoma

We report 3 cases of primary extranodal lymphoma of the prostate, an unusual extranodal presentation rarely diagnosed antemortem. Symptoms of prostatism associated with an enlarged hard prostate with pyuria and hematuria in younger patients should suggest the diagnosis. Urine cytologic examination should aid in the diagnosis of this condition.     

Five-year prognosis after radical prostatectomy in a patient with localized prostate cancer and incidental non-Hodgkin's lymphoma

We present a white male patient with an initial prostate-specific antigen level of 69 ng/ml, referred for urological evaluation. He was found to be free of prostatitis but diagnosed for prostate adenocarcinoma without any indications of metastatic disease. Lymphadenectomy then revealed lymphadenopathy of low-grade non-Hodgkin's lymphoma. Five-year follow-up after radical retropubic prostatectomy (RRP) showed no evidence of metastatic or local prostate cancer recurrence. In addition, no radiation or chemotherapy was required for his lymphoma. Although RRP is a viable option in this unique case, the outcome thus far suggests that it should be considered a primary therapeutic modality.