原發性儲精囊腺癌—病例報告
蔡博超1、陳奕先2、王中敬1、張謙行1
天主教中華聖母修女會醫療財團法人天主教聖馬爾定醫院：1泌尿外科，2病理科
Primary adenocarcinoma of the seminal vesicles – Case report
Po-Chao Tsai1, Yi-Hisen Chen2, Chung-Jing Wang1, Chien-Hsing Chang1
Department of Urology1 and Pathology2, St. Martin De Porres Hospital, Chiayi, Taiwan
Purpose: We present a case of very rare malignant neoplasm derived from the gland of the seminal vesicles.
Case presentation: The case involves a 53-year-old man who has diabetes mellitus under poor control before hospitalization. He came to our emergency department due to general weakness and poor appetite. He denied diarrhea, constipation, or dysuria. The physical examination revealed chronically-ill appearance and clear consciousness. There was no icteric sclera, no knocking tenderness of the flank area, and no tenderness of the abdomen. The digital rectal examination showed a palpable rectal mass about 8cm above anal verge. Urinalysis showed numerous red blood cells and white blood cells under high-powered-fields. The serum survey revealed high C-reactive protein(18.24 mg/dL), no leukocytosis, and low albumin(2.8g/dL). The tumor marker work-up showed high Carcinoembryonic antigen(12.3 ng/mL) and high specific prostate antigen(21.5ng/mL). A colonoscopy was performed and showed an ulcerative rectal mass. The pathology report from an endoscopic biopsy indicated adenomatous mucosa without dysplasia. Computed tomography and a magnetic resonance image of pelvis were taken. The films showed a large cystic lesion(4.4cm in diameter) and solid component between the prostate and the rectum. The origin could not be identified from the images. A transrectal ultrasound-guided cyst aspiration and tumor biopsy with prostate biopsy were then performed. The pathology report indicated adenocarcinoma with moderate to poor differentiation. The immunohistochemical stains showed mucicarmine(+), CK(+), CK7(+), CK20(-), CDX2(-), PSA(-), androgen receptor(-), TTF-1(-), CEA(+), and CA125(+). These are typical pathological findings of primary adenocarcinoma of the seminal vesicles.
Conclusions: Primary adenocarcinoma of the seminal vesicles is a very rare neoplasm. It is difficult to be diagnosed by medical physicians or even urologists. We want to share the images and our experience with colleagues in clinical work to improve the investigation of similar cases.