Urologia 2013 ; 79 ( 1 ): 247- 250
DOI: 10.5301/urologia.5000028
CASE REPORTS
A rare case of primary mantle cell lymphoma of the prostate: Clinical aspects and open problems Alberto Gurioli, Francesco Marson, Francesca Pisano, Francesco Soria, Daniele Lorenzo, Donatella Pacchioni, Bruno Frea, Paolo Gontero Clinica Urologica Universitaria, Turin – Italy
Primary Mantle Cell Prostatic Lymphoma Abstract: A case of primary prostate involvement by mantle-cell lymphoma diagnosed at the time of transvesical adenomectomy is reported. Diagnostic difficulties and clinical outcome are also presented. The possibility of prostate involvement by malignant lymphomas, albeit rare, should be considered in any case of histological evidence of dense prostate lymphoid infiltrate in patients with lower urinary tract obstruction, and should be highly suspected in patients with prior history of systemic lymphoma. Immunohistochemical analysis is essential for a correct diagnosis. Both urologists and pathologists should be aware of the existence of such a rare clinical condition. Key words: Prostate, Mantle cell, Lymphoma, Hematuria, LUTS, SOX11 Parole chiave: ??? Accepted: July 16, 2013
INTRODUCTION Prostate involvement by malignant lymphomas may occur both as a primary or secondary event, but it remains an extremely rare condition with a global incidence of less than 200 cases reported worldwide (1). Furthermore, the mantle-cell variant is far less common, with an overall prevalence of only six cases described in literature: we report the third case in literature of a mantlecell lymphoma with primary prostatic localization and aim to shed some light on the diagnostic difficulties and clinical outcome of this rare clinical condition.
CASE PRESENTATION An 83-year-old man with hypertension, chronic obstructive broncopneumopathy and hyperthyroidism was admitted at the emergency department of our hospital because of gross hematuria and weight loss.
He was regularly under control for MGUS, diagnosed several years before, and chronic renal insufficiency. He had an indwelling catheter recently placed for acute urine retention. A large, benign-feeling prostate, exceeding 100 grams, was palpable. A thoracic and abdominal CT showed nodular lesions (14 mm diam.) located at the superior pulmonary lobes on each side and several enlarged nodes (23 mm diam.) located in the anterior mediastinum and in left para-aortic region. A 5 cm kidney mass at the upper pole of the right kidney, with infiltrative pattern, involvement of the perirenal fat and compression of the upper calyceal system was also evident. A large prostatic medium lobe protruded in the bladder without hydronephrosis. After a multidisciplinary consultation involving both oncologists and urologists, it was decided not to proceed to debulking nephrectomy due to patient’s age and comorbidities, and to opt for palliative care only. The patient underwent transvesical adenomectomy; the catheter was successfully removed after 1 week. Histology
© 2013 Wichtig Editore - ISSN 0391-5603
247
Prostate Neoplasms and Benign Prostatic Hyperplasia
Fig. 1 - Macroblock section stained with Hematoxylin Eosin.
of the prostate showed BPH associated with a monoclonal lymphocyte pattern that HIC analysis characterized as mantle cell lymphoma. No further treatment was needed considering the patient’s age and global performance status.
DISCUSSION Gross findings The surgical specimen consisted of two fragments (cm 8 × 5 × 4 and 6 × 4 × 3, respectively) that were inked, sectioned and entirely examined with macrosections. The cut surface showed numerous nodules of parenchyma, usually tan-white and firm, sometimes spongy. Pure stromal nodule had a tan-gray to white whorled appearance. Secondary infarction was present and was characteristically yellow-red. Sections of macroblocks were stained with Hematoxylin and Eosin for histopathological evaluation (Fig. 1).
Microscopic findings The microscopic evaluation showed the classical feature of nodular hyperplasia. Multiple nodular aggregates ranging from
DOI: 10.5301/urologia.5000028
CASE REPORTS
A rare case of primary mantle cell lymphoma of the prostate: Clinical aspects and open problems Alberto Gurioli, Francesco Marson, Francesca Pisano, Francesco Soria, Daniele Lorenzo, Donatella Pacchioni, Bruno Frea, Paolo Gontero Clinica Urologica Universitaria, Turin – Italy
Primary Mantle Cell Prostatic Lymphoma Abstract: A case of primary prostate involvement by mantle-cell lymphoma diagnosed at the time of transvesical adenomectomy is reported. Diagnostic difficulties and clinical outcome are also presented. The possibility of prostate involvement by malignant lymphomas, albeit rare, should be considered in any case of histological evidence of dense prostate lymphoid infiltrate in patients with lower urinary tract obstruction, and should be highly suspected in patients with prior history of systemic lymphoma. Immunohistochemical analysis is essential for a correct diagnosis. Both urologists and pathologists should be aware of the existence of such a rare clinical condition. Key words: Prostate, Mantle cell, Lymphoma, Hematuria, LUTS, SOX11 Parole chiave: ??? Accepted: July 16, 2013
INTRODUCTION Prostate involvement by malignant lymphomas may occur both as a primary or secondary event, but it remains an extremely rare condition with a global incidence of less than 200 cases reported worldwide (1). Furthermore, the mantle-cell variant is far less common, with an overall prevalence of only six cases described in literature: we report the third case in literature of a mantlecell lymphoma with primary prostatic localization and aim to shed some light on the diagnostic difficulties and clinical outcome of this rare clinical condition.
CASE PRESENTATION An 83-year-old man with hypertension, chronic obstructive broncopneumopathy and hyperthyroidism was admitted at the emergency department of our hospital because of gross hematuria and weight loss.
He was regularly under control for MGUS, diagnosed several years before, and chronic renal insufficiency. He had an indwelling catheter recently placed for acute urine retention. A large, benign-feeling prostate, exceeding 100 grams, was palpable. A thoracic and abdominal CT showed nodular lesions (14 mm diam.) located at the superior pulmonary lobes on each side and several enlarged nodes (23 mm diam.) located in the anterior mediastinum and in left para-aortic region. A 5 cm kidney mass at the upper pole of the right kidney, with infiltrative pattern, involvement of the perirenal fat and compression of the upper calyceal system was also evident. A large prostatic medium lobe protruded in the bladder without hydronephrosis. After a multidisciplinary consultation involving both oncologists and urologists, it was decided not to proceed to debulking nephrectomy due to patient’s age and comorbidities, and to opt for palliative care only. The patient underwent transvesical adenomectomy; the catheter was successfully removed after 1 week. Histology
© 2013 Wichtig Editore - ISSN 0391-5603
247
Prostate Neoplasms and Benign Prostatic Hyperplasia
Fig. 1 - Macroblock section stained with Hematoxylin Eosin.
of the prostate showed BPH associated with a monoclonal lymphocyte pattern that HIC analysis characterized as mantle cell lymphoma. No further treatment was needed considering the patient’s age and global performance status.
DISCUSSION Gross findings The surgical specimen consisted of two fragments (cm 8 × 5 × 4 and 6 × 4 × 3, respectively) that were inked, sectioned and entirely examined with macrosections. The cut surface showed numerous nodules of parenchyma, usually tan-white and firm, sometimes spongy. Pure stromal nodule had a tan-gray to white whorled appearance. Secondary infarction was present and was characteristically yellow-red. Sections of macroblocks were stained with Hematoxylin and Eosin for histopathological evaluation (Fig. 1).
Microscopic findings The microscopic evaluation showed the classical feature of nodular hyperplasia. Multiple nodular aggregates ranging from
