陳祺方^{1, 2}、陳俐臻^{1, 2}

¹馬偕紀念醫院泌尿科, ²馬偕醫學院

Chi-Fang, Chen ^{1, 2}. Li-Chen, Chen^{1, 2}

¹Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan

²Department of Medicine, Mackay Medical College, Taipei, Taiwan

 

Background

Lymphoma presented in prostate is rare. and accounts for ~0.1% of all newly diagnosed lymphomas. The etiology remains poorly understood. Clinical and histopathology data of a 68-year-old patient who underwent transurethral resection of the prostate was obtained. We report one case of non-Hodgkin lymphoma of the prostate in a 68-year-old male who presented with PSA elevation and lower urinary tract symptoms.

 

Case presentation

This 68-year-old male patient was diagnosed Non-Hodgkin lymphoma of prostate which tissue was obtained by laser transurethral resection of prostate (TURP) In 2017, he presented to our outpatient-department with nocutria and urinary hesitancy for half year. His IPSS score was 3 points. His prosate spefisic antigen (PSA) was 5.29 ng/mL. Recheck free to total PSA ratio was 21.5%( 0.972/4.51 ng/mL) Uroflowmetry(UFM) revealed low flow rate(3.1ml/s) with residual urine 73 ml. The digital rectal exam showed elastic consistency without mass lesion. Patient denied weight loss, nocturnal sweats, or fever. However, he had past history of low grade follicular lymphoma, which was found by sigmoid colon polyp biopsy. Follow-up Ga-67 tumor survey and colonoscope revealed inflammatory polyp without residual tumor. Dutasteride and tamsulosin was prescribed, but symptom progressed with nocturia and urine retention (prostate volume: 43gm, UFM: Qmax 6.6 ml/s, residual urine: 170ml) In 2019, PSA elevated to 5.77ng/mL. Thus, 12-core transrectal biopsy of prostate was performed, which showed free of malignancy. In Feb, 2020, because of lower urinary tract symptoms with urine retention despite of medication, he received laser TURP (transurethral resection of prostate.) 22 gm prostate tissue was resected, and the pathology report showed non-Hodgkin lymphoma. Further tumor survey with Whole body PET/CT scan and Contrast enhanced computerized tomography of the abdomen showed tumor involving the prostate gland and right guteal lymph node. No distant metastasis was found. Blood profile showed LDH over normal limit 193 IU/L and HBV, HCV in negtive results. The postoperative course was uneventful. The patient now was referred to hematologsit for further chemotherapy.

 

Conclusion

Non-Hodgkin lymphoma involving the prostate is a rare disease. PSA elevation with storage symptoms during voiding probably indicated lymphoma if the patient had previous lymphoma history. The diagnosis is important because further treatment choice consistency with the specific histological diagnosis can be effective. We reported one case of lymphoma involving prostate, which was incidentally found after laser TURP with unusual presentation. More cases may be need for further studies in the further. If we have had noted the lymphoma earlier, we could provided other treatment options to the patient.