Phyllodes tumor of the prostate with exuberant glandular hyperplasia

Reported herein is an unusual case of prostatic phyllodes tumor with exuberant glandular hyperplasia that led to misdiagnosis of adenocarcinoma. The tumor was detected in a 52-year-old man who had a 1 year history of dysuria. Adenocarcinoma of the prostate was diagnosed from a needle biopsy specimen. The patient received hormonal therapy for 6 months and underwent radical prostatectomy. Histologically, the tumor had an atypical stromal cell proliferation and elongated slit-like glands characteristic of a phyllodes tumor. The tumor was also accompanied by a florid proliferation of small acini, most of which lacked basal cells, a common manifestation of adenocarcinoma in the overall tumor area. The following features of the resected tumor were helpful for concluding that these acini were benign: lack of cytological anaplasia in spite of structural atypia, presence of scattered basal cells confirmed by immunohistochemistry (high-molecular-weight cytokeratin), and histological transition from these acini to apparently benign slit-like glands. The final diagnosis was then made as 'phyllodes tumor of the prostate with exuberant glandular hyperplasia'. Atypical stromal cells might provide a clue for the recognition of this rare tumor at initial diagnosis by needle biopsy.     

Giant cystosarcoma phyllodes of the prostate associated with adenocarcinoma.

Cystosarcoma phyllodes of the prostate is a rare neoplasm, occurring in adult men. It closely resembles the not uncommon tumor of the female breast and usually behaves in a similar manner. This case of benign cystosarcoma phyllodes of the prostate occurred in a 53-year-old man who presented with increasing abdominal girth and underwent exploratory laparotomy and removal of the 11.2-kg tumor. It was remarkable for its very large size and the presence of foci of well-differentiated adenocarcinoma, prostatic acinar type. The glandular epithelium of both the phyllodes tumor and the carcinoma were immunoreactive for cytokeratin, epithelial membrane antigen, prostate-specific antigen, and prostate-specific acid phosphatase. The presence of typical prostatic type adenocarcinoma and this immunoreactivity pattern strongly supports a prostatic origin for this rare neoplasm.     

Morphological variations of the human ejaculatory ducts in relation to the prostatic urethra

Loss of ejaculation can follow transurethral resection of the prostate (TURP). Periverumontanal prostate tissue is preserved in ejaculation‐preserving TURP (ep‐TURP). Knowledge of ejaculatory duct anatomy in relation to the prostatic urethra can help in ep‐TURP. This was evaluated in cross‐sections of the prostate using a 3 D model to determine a safe zone for resecting the prostate in ep‐TURP. A 3 D reconstruction of the ejaculatory ducts was developed on the basis of six prostate gland cross‐sections. The measurements obtained from the 3 D model were standardized according to the maximum width of the prostate. Simple linear regressions were used to predict the relationships of the ejaculatory ducts. The maximum widths of the prostates ranged from 22.60 to 52.10 mm. The ejaculatory ducts entered the prostate with a concavity directed posterolaterally. They then proceeded toward the seminal colliculus in a fairly straight course, and from that point they angulated anteromedially. As they opened into the prostatic urethra they diverged. Significant regression models predicted the relationships of the ejaculatory ducts to the prostatic urethra based on the sizes of the prostates. The 3 D anatomy of ejaculatory ducts can be predicted on the basis of prostate width. The ejaculatory ducts can be preserved with 95% accuracy if a block of tissue 7.5 mm from the midline on either side of the seminal colliculus is preserved, up to 10 mm proximal to the level of the seminal colliculus, during TURP. Clin. Anat. 31:456–461, 2018. © 2017 Wiley Periodicals, Inc.     

De novo large cell neuroendocrine carcinoma of the prostate gland with pelvic lymph node metastasis: a case report with review of literature

Neuroendocrine (NE) differentiation in prostate carcinomas can be seen in two settings: as a focal finding in conventional acinar adenocarcinoma, identifiable by immunohistochemical staining, or as a primary NE tumor of the prostate gland, such as carcinoid, small cell carcinoma, or large cell NE carcinoma. Of particular interest is the large cell NE carcinoma, which had been previously reported in isolated cases or in limited case series. In this report, we describe a case of a large cell NE carcinoma diagnosed in a 48-year-old man who presented with difficulty in voiding and urine retention. A cystoscopy revealed an enlarged, elongated prostate with an intra-urethral obstructing mass in the prostatic urethra. Subsequently, a transurethral resection of prostate (TURP) was performed at an outside hospital under the clinical diagnosis of benign prostatic hyperplasia (BPH). Microscopic examination of the TURP specimen revealed several foci of low-grade transitional-zone-type adenocarcinoma corresponding to Gleason score 5 (3 + 2), and a focus of high-grade large cell NE carcinoma. Concurrent x-ray computed tomography scans of the chest, abdomen, and pelvis demonstrated an enlarged left pelvic lymph node, which was biopsied and the patient was diagnosed with metastatic large cell NE carcinoma. He subsequently underwent 8 cycles of neoadjuvant chemotherapy with Lupron, a laparoscopic robotic-assisted radical retropubic prostatectomy, and pelvic lymphadenectomy. He died of widely metastatic prostatic carcinoma with leptomeningeal metastases 13 months after radical prostatectomy. Here, we present a rare case of large cell NE carcinoma with a review of the published literature.     

Phyllodes tumor of the seminal vesicle: case report and literature review

A 39-year-old man presented with urinary retention and lower abdominal discomfort at our hospital, and a computed tomography scan showed a huge cystic mass posterior to the urinary bladder. During surgical exploration, a mass superior to the prostate in the region of the left seminal vesicle was found. Histologically, the tumor was characterized by cystically dilated or slit-like glands mixed in a densely cellular stroma with pleomorphism and resembled those of phyllodes tumor of the breast or prostate. The glandular epithelium within the tumor showed focal lipofuscin pigment and negative staining for prostate specific antigen (PSA). The stromal cells showed positive immunoreactivity for vimentin and CD34, and focal positive reactions for desmin and alpha-smooth muscle actin. Mitosis was present 0 to 1 per 10 high power fields of magnification in the stromal cells. Approximately 20% of the stromal cells were positive for progesterone receptor. The patient is alive with no evidence of disease 12 months after surgery. Mixed epithelial-stromal tumors of the seminal vesicle are extremely rare. A combination of stromal cellularity, atypia and mitosis might be used for the histological grading, and a prostatic origin might be excluded by the location of the primary lesion itself and by the failure to show PSA.     

Treatment of benign prostatic hyperplasia with 5-alpha-reductase inhibitor: morphological changes in patients who fail to respond.

AIMS: To describe the prostatic adenectomy specimens of six patients with symptomatic benign prostatic hyperplasia (BPH) who failed to respond to long term treatment with a 5-alpha-reductase inhibitor, finasteride. METHODS: Histological sections from six cases of BPH who had been treated with finasteride were investigated. Five patients were prescribed 5 mg finasteride daily for six months and one patient 5 mg daily for 12 months. The patients underwent adenectomy as their urethral obstruction failed to resolve. Twenty cases of untreated BPH served as controls. RESULTS: In patients taking finasteride for six months the prostatic adenectomy specimens showed a reduction in the size of the prostate and an increase in the stroma:epithelial and stroma:lumen ratios compared with controls. The size of the ducts and acini was not as uniform as in the controls. In particular, some ducts and acini were still lined by a bistratified epithelium similar to that found in controls but lacked undulations at the epithelial border; other ducts/acini were atrophic. Some scattered clusters of small acini with a focally fragmented basal cell layer were observed in two of the five treated cases. One prostatic adenectomy specimen, from the patient treated for one year, showed extensive lobular atrophy and diffuse squamous and transitional cell metaplasia. At the periphery of the transition zone, there was a complex intra-acinar papillary-cribriform proliferation of clear cells without nuclear atypia, similar to clear cell papillary hyperplasia. The periurethral region showed stromal nodules in both patients and controls. CONCLUSIONS: Morphological evaluation of finasteride treated BPH showed changes in the lobules of the transition zone, but not in the periurethral stroma.     

经尿道电切术治疗表浅性膀胱癌合并良性前列腺增生的临床分析

目的探讨合并良性前列腺增生（BPH）的表浅性膀胱癌（SBC）患者同期行经尿道膀胱肿瘤及前列腺电切术的有效性及安全性。方法回顾性研究32例（研究组）同期行经尿道膀胱肿瘤电切（TURBT）及经尿道前列腺电切（TURP）患者和35例（对照组）仅行TURBT的患者,术后均按疗程行羟基喜树碱20mg膀胱灌注,两组在年龄、肿瘤大小、肿瘤分期分级等方面差异均无统计学意义（P〉0．05）。结果所有患者均顺利完成手术,随访期限为1—3年,平均1．8年。研究组膀胱肿瘤复发率为46．9％,对照组复发率为45．7％,平均复发时间研究组为16个月、对照组为13个月,两组间差异均无统计学意义（P〉0．05）。研究组术后复发病例中未发生前列腺窝种植。结论对于合并BPH的SBC患者,同期行TURBT＋TURP术是比较安全有效的方法,同时不增加前列腺窝内肿瘤种植的几率。     

Effects of combination endocrine treatment on normal prostate, prostatic intraepithelial neoplasia, and prostatic adenocarcinoma.

AIMS--To investigate the effect of combination endocrine treatment (CET) or luteinising hormone releasing hormone agonist and flutamide on non-neoplastic prostate, prostatic intraepithelial neoplasia, and prostatic adenocarcinoma. METHODS--The morphology, including the mitotic activity, of 12 radical prostatectomies from patients with prostatic adenocarcinoma pretreated for three months with CET was evaluated in haematoxylin and eosin stained sections and compared with an untreated age and stage matched control group. RESULTS--A differential effect on the non-neoplastic prostate was observed. In fact, the transition zone of the treated prostate showed simplification of the glandular lobules: the ducts and acini were small without undulations of the epithelial border and with a prominent basal cell layer. Within the peripheral zone there was inconspicuous branching of the ducts and acini which looked dilatated and lined by flattened atrophic epithelium. Prostatic intraepithelial neoplasia occurred in scattered ducts and acini in the peripheral zone of 10 of the 12 patients. The epithelial cell lining showed a prominent basal cell layer. A certain degree of secretory cell type stratification was always present. However, crowding was less evident than in the untreated prostate because of cytoplasmic clearing and enlargement as a result of coalescence of vacuoles. The treated adenocarcinomas had neoplastic acini which looked small and shrunken, and areas of individual infiltrating tumour cells separated by abundant interglandular connective tissue. The secretory cells of the nonneoplastic, prostatic intraepithelial neoplasia, and prostatic adenocarcinoma lesions had inconspicuous nucleoli, nuclear shrinkage, chromatin condensation, and cytoplasmic clearing. Apoptotic bodies were easily identifiable in all the cell layers. The lumina were rich in macrophages, sloughed secretory cells with degenerative features, and apoptotic bodies. Mitoses were not observed in any of the treated non-neoplastic prostate, prostatic intraepithelial neoplasia, or prostatic adenocarcinomas, whereas the mitotic frequency increased from non-neoplastic prostate through prostatic intraepithelial neoplasia up to prostatic adenocarcinomas in the untreated specimens. CONCLUSIONS--CET before radical prostatectomy causes regressive epithelial changes together with enhanced apoptosis and blocked mitotic activity.     

Malignant phyllodes tumor of the prostate

Phyllodes tumor of the prostate is rare. We have recently experienced a case of phyllodes tumor of the prostate in a 57-year-old man who complained of urinary retention for 1 year. The epithelial components were positive reactivity for prostate specific antigen. The stromal cells showed nuclear atypia with increased mitotic activity. The tumor was diagnosed as a malignant phyllodes tumor as it invaded into the urinary bladder and rectum, and grew rapidly immediately after operation. We describe the morphological features and immunohistochemical findings of malignant phyllodes tumor and review the literature.     

Pleomorphic giant cell carcinoma of the prostate

We report the clinical and pathologic features of 2 cases of pleomorphic giant cell carcinoma of the prostate. One case was found at autopsy in a 77-year-old man and was composed of high-grade prostatic adenocarcinoma with prominent anaplastic giant cells. The patient presented with metastases to multiple retroperitoneal lymph nodes, liver, and lumbar vertebrae. The second case occurred in a 45-year-old man who underwent transurethral resection of the prostate and was found to have high-grade prostatic adenocarcinoma with an extensive anaplastic giant cell component. The patient presented with distant metastases and died within 9 months. Both regular adenocarcinoma and anaplastic giant tumor cells displayed cytoplasmic immunoreactivity for prostate-specific antigen, prostatic acid phosphatase, and keratin AE1/AE3; in one case, scattered cells were also positive for chromogranin and epithelial membrane antigen. Pleomorphic giant cell carcinoma is a rare variant of prostatic adenocarcinoma with a poor prognosis that should be considered in the differential diagnosis of prostatic pleomorphic tumors.     

Comparative Study of Prostatic Utricle in Rat,Rabbit, Dog and Man

The prostatic utricle is one of the auxiliary glands associated with the genital duct systems in males. In man it is described as a blind pouch about 6mm long, situated in the median lobe of prostate, opens into the urethra in the median line of colliculus seminalis; and contains mucous glands and smooth muscle fibres. It is a vestigial structure representing the lower fused segments or remnants of Mullerian or paramesonephric ducts and analogous to uterovaginal canal in female.There is no constant view about the presence and the structure of prostatic utricle in different animals so it is essential in the field of research of genital accessory glands to have an accepted view about the presence, the structure and the nature of secretion of prostatic utricle in animals.The present work simply provides general architecture, level of opening and nature of secretion of the prostatic utricle by histological observations with various stains on total 15 animals. The prostatic utricle was identified in all the studied animals; however it varied in its size, shape and structure. Proportionally the largest prostatic utricle was found in rabbit where it was a large elongated pouch with mucosa; submucosa and muscular coats; situated behind the prostate and opened at the median line of posterior wall of prostatic urethra. The prostatic utricle in man and dog was in the form of an elongated cavity with numerous glands; embedded in the urethral crest and opened at the median line of posterior wall of prostatic urethra. In rat it was a minor structure in the form of a few tubules in the substance of urethral crest and opened at the either side of median line of posterior wall of prostatic urethra. The secretion of mucoprotein nature was seen in the prostatic utricle and its glands; in all these studied animals.     

前列腺增生并肾后性肾功能不全的治疗方法

目的：探讨前列腺增生并肾后性肾功能损害的处理方法及手术时机及其术后效果。方法：对30例前列腺增生并肾后性肾功能损害的患者,经留置尿管或耻骨上膀胱穿刺造瘘尿液引流,在肾功能恢复和尿动力检查膀胱逼尿肌功能恢复的前提下行经尿道前列腺电切。结果：经持续尿液引流后肾功均有明显改善,其中22例于1周后成功行前列腺电切,8例行膀胱造瘘后1～2月行前列腺电切术,手术中及术后顺利,均无严重并发症,术后顺访1～2年,排尿通畅满意,肾功能正常。结论：尿液引流是首要处理方法,肾功能恢复及膀胱逼尿肌功能恢复是手术的前提,经尿道前列腺电切是手术的主要方法。     

Amplifications of EGFR gene and protein expression of EGFR, Her-2/neu, c-kit, and androgen receptor in phyllodes tumor of the prostate.

Phyllodes tumor of the prostate is a rare neoplasm with an unpredictable clinical behavior. It may undergo early recurrence with sarcomatous transformation or may even metastasize. Because targeted therapies have shown great success against several malignancies, there is hope that these same therapies may show similar promise in the treatment of other neoplasms. This study was undertaken to investigate both amplification of the epidermal growth factor receptor (EGFR) gene by fluorescence in situ hybridization and the overexpression of EGFR, Her-2/neu, CD117 (c-kit), and androgen receptor by immunohistochemical staining in a series of 11 phyllodes tumors of the prostate. In the stromal elements, EGFR gene amplification was present in four of 11 tumors and polysomy chromosome 7 was present in two of 11 tumors. No amplification was present in the epithelial components. Only one of 11 tumors had polysomy of chromosome 7 in the epithelial components. Immunohistochemically, in the stromal components, EGFR expression was demonstrable in four of 11 tumors and androgen receptor was demonstrated in six of 10 tumors. Neither Her-2/neu nor c-kit expression was seen in the stromal components of any of the 11 tumors. In the epithelial components, EGFR expression was present in all 11 tumors with strong staining in the basal cell layers and weak or no staining in luminal epithelium; androgen receptor expression was seen in seven of 10 tumors; Her-2/neu was weakly positive in four of 11 tumors; and c-kit expression was present focally and weakly in two of 11 cases with only 2-5% of cells staining. The highest staining intensity and the highest percentage of positively staining cells were seen with EGFR immunostaining in both the stromal and epithelial (mainly basal cells) components. Androgen receptor staining showed the next highest staining intensity and percentage of positive cells in both components. Her-2/neu and c-kit were only weakly or infrequently expressed in the epithelial components of prostatic phyllodes tumors. Our data indicate that EGFR and androgen receptor are frequently and strongly expressed in both epithelial and stromal components of prostatic phyllodes tumors. EGFR gene amplification is frequently present in prostatic phyllodes tumors and may account for one of the mechanisms leading to protein overexpression in some but not all cases. Anti-EGFR and/or antiandrogen agents may be potentially useful for management of patients with tumors expressing EGFR and/or androgen receptor.     

Granulomatous prostatitis: a clinicopathological study

In a clinicopathological study of granulomatous prostatitis, we have found two distinct histological patterns. Approximately one third of cases consisted of localized, often elongated or stellate lesions, resembling rheumatoid nodules. Where clinical details were available, most of these cases had a history of previous transurethral resection. The remaining cases showed more diffuse involvement of the prostate, with lesions centred on ducts and glands, and were not associated with previous prostatic surgery or systemic illness. Immunohistochemical studies of the associated inflammatory infiltrate showed an apparently random distribution of T- and B-lymphocytes in the former group, while in the latter group there was a concentration of T-cells in and around damaged ducts and glands, suggesting a possible immune-mediated destruction of these structures.     

Prostatic phyllodes tumor, a rare entity. Anatamo-clinical and immunohistochemical study of 1 case

We report the case of a prostatic phyllodes tumor in a 47-year-old man. It measured 6 cm and was composed of a glandular component with leaf-like architecture, lined with two cellular layers, and a moderately cellular stromal component, with no atypia and no mitosis. Basal cells were marked with high-molecular-weight cytokeratin antibody (34BE12) and stromal cells were marked with anti-vimentin and for some of them with CD34 antibodies. Prostatic phyllodes tumor is a rare lesion with uncertain prognosis. Total surgical removal is necessary because malignant transformation to high-grade sarcoma has been reported. In our case the development of the tumor at the posterior side of the prostate, the lack of PSA immunoreactivity and the presence of mucinous glands, sometimes "endocervical-like", could suggest an origin from embryonic mullerian remnants in the prostatic utricle rather than urogenital sinus.     

Prostate epithelial Pten/TP53 loss leads to transformation of multipotential progenitors and epithelial to mesenchymal transition

Loss of PTEN and loss of TP53 are common genetic aberrations occurring in prostate cancer. PTEN and TP53 contribute to the regulation of self-renewal and differentiation in prostate progenitors, presumptive tumor initiating cells for prostate cancer. Here we characterize the transformed phenotypes resulting from deletion of the Pten and TP53 tumor suppressors in prostate epithelium. Using the PB-Cre4(+)Pten(fl/fl)TP53(fl/fl) model of prostate cancer, we describe the histological and metastatic properties of primary tumors, transplanted primary tumor cells, and clonal cell lines established from tumors. Adenocarcinoma was the major primary tumor type that developed, which progressed to lethal sarcomatoid carcinoma at approximately 6 months of age. In addition, basal carcinomas and prostatic urothelial carcinomas were observed. We show that tumor heterogeneity resulted, at least in part, from the transformation of multipotential progenitors. CK8+ luminal epithelial cells were capable of undergoing epithelial to mesenchymal transition in vivo to sarcomatoid carcinomas containing osseous metaplasia. Metastasis rarely was observed from primary tumors, but metastasis to lung and lymph nodes occurred frequently from orthotopic tumors initiated from a biphenotypic clonal cell line. Androgen deprivation influenced the differentiated phenotypes of metastases. These data show that one functional consequence of Pten/TP53 loss in prostate epithelium is lineage plasticity of transformed cells.     

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.     

Phyllodes tumor of the prostate

In this report, we describe a case of phyllodes tumor of the prostate with a high value of prostate-specific antigen (PSA). A 47-year-old man with symptoms of hematospermia presented with a steadily elevated serum PSA value of 60.76 ng/mL (normal range, < 4 ng/mL). A needle biopsy revealed atypical stromal cells without any evidence of malignancy. After radical prostatectomy, the tumor measured 2.9 cm in diameter and consisted of a single nodule composed of irregular, elongated epithelial ducts and atypical stromal cells with enlarged, occasionally multinucleated, pleomorphic, or hyperchromatic nuclei. Immunohistochemistry showed that the atypical stromal cells were positive for vimentin, androgen receptor, estrogen receptor, progesterone, and 5α-reductase, but negative for MIB-1, PSA, SMA, p53, desmin, CD34, c-kit, CD10, S-100, and EGFR. Excess PSA might be secreted by hyperplastic luminal cells driven by 5α-reductase-positive stromal and epithelial cells. Array-comparative genomic hybridization (array CGH) for genomic alterations revealed a gain of 11p13, which includes the WT1 gene, and a loss of 1p36.23 and 12p12.1. After surgery, the serum PSA value rapidly decreased to within the normal range; no recurrence or distant metastasis was noted after 2 years of follow up.     

Malignant phyllodes tumor of the breast with predominant chondrosarcomatous differentiation

Malignant phyllodes tumor of the breast is a rare biphasic neoplasm, the stromal component of which may show homologous and heterologous sarcomatous elements. We present a case of a histologically malignant phyllodes tumor with sarcomatous overgrowth, affecting a 37-year-old woman in whom a chondrosarcomatous component constituted over 80% of the tumor volume. A malignant phyllodes tumor displaying a predominant chondrosarcomatous component is indeed rare, and the differential diagnosis could well affect the therapeutic approach, mainly with regard to metaplastic carcinoma and primary chondrosarcoma of the mammary gland. Thus, it is important to sample the tumor thoroughly to detect the presence of any area of typical phyllodes tumor, which could be very small. Immunohistochemical stains also should be performed so as to exclude a malignant epithelial component. After the final morphological diagnosis, our patient underwent a complete mastectomy without axillary disection. One year later, no local recurrence or metastasis was apparent.     

经尿道前列腺切除术术后并发症的处理（附10例病例分析）

目的探讨经尿道前列腺切除术后常见并发症的原因、预防和处理方法。方法回顾分析我院经尿道前列腺电切术治疗良性前列腺增生症165例的临床资料,出现10例并发症,给予正确的处理方法治疗。结果1例包膜穿孔致电切综合征经迅速结束手术,积极对症治疗,生命体征平稳,术后排尿顺畅。术中出血及术后继发出血4例,1例经放置三腔单囊尿管,持续盐水或冰盐水膀胱冲洗,配合止血药物治疗,也未再次发生出血,术后排尿顺畅,余三例经止血对症处理未发生再出血。3例术后尿潴留,均经尿道扩张术结合口服对症药物,3例均无再次尿潴留,术后1～3个月复查,尿流率>15ml/s,1例尿道外口狭窄者定期尿道扩张1个月,排尿顺畅,尿失禁1例,经过括约肌锻炼,逐步恢复正常排尿。结论出血、尿潴留、尿道狭窄、电切综合征是经尿道前列腺切除术后常见并发症,严格掌握手术指征,熟练细致地操作,及时有效地处理可以避免出现严重后果。