黃裕賓¹、黃志賢^1,2、張延驊^1,2

台北榮民總醫院 泌尿部¹；國立陽明大學醫學院 泌尿學科 書田泌尿科學研究中²

Yu-Pin Huang¹, William J. Huang^1,2,Yen-Hwa Chang^1,2

Department of Urology, Taipei Veterans General Hospital¹

Department of Urology, School of Medicine and Shu-Tien Urological Institute,

National Yang-Ming University, Taipei, Taiwan²

 

Primary tumors of the seminal vesicle are very uncommon. Exclusively, neuroendocrine carcinoma of seminal vesicle is extremely rare. Therefore, we report a case of primary small cell neuroendocrine carcinoma (SCNEC) of the seminal vesicle in an elderly gentleman.

A 71-year-old man who had hyperlipidemia but denied prior operation history presented with dry cough, Rt testicular pain, hematospermia and weight loss of 6 kgs in three weeks. He visited Chest Medicine out-patient clinic with negative findings of CXR. He was then transferred to Urology clinic, where digital rectal exam revealed a huge irregularly stony hard prostate bulging into rectum. Serum prostate specific antigen (PSA) was 36.10 ng/ml (normal <4.0). Lactic dehydrogenase (LDH) was 734 U/L (normal <250). He underwent trans-rectal ultrasound guided (TRUS) biopsy under the impression of prostate cancer with pathology report of benign prostatic tissue in all 12 cores. Further imaging survey (CT and bone scans) disclosed left seminal vesicle tumor with rectum invasion and multiple lung, liver and bone metastasis. Hence, targeted biopsy of seminal vesicles and prostate were performed again. Pathology confirmed benign prostate tissue and SCNEC from left seminal vesicle. According, SCNEC carries a poor prognosis with limited treatment options and chemotherapy remains the mainstay therapy. Recently, immune checkpoint inhibitor (ICI) nivolumab may provide good response for SCNEC in case report^1,2. Owing to the patient’s poor performance and his preference, he initiated immunotherapy with Nivolumab 200 mg iv q2w since 2017/11/15 for three doses with initial good clinical response. However, he developed general weakness with chest pain and legs edema at 10 days after last Nivolumab dose. FU image study disclosed disease progression in all metastatic lesions and liver function decompensation (increase level of ALT/AST, ALK-P, γ-GT and total bilirubin). Best supportive care was introduced and he died of terminal cancer.

Few cases of small cell neuroendocrine carcinoma (SCNEC) of seminal vesicle had been reported. The ominous outcome of SCNEC results from its rapid disease progression as well as poor response to currently available treatment. In this case report, immune checkpoint inhibitor with nivolumab did not show to have treatment response as reported in the literature.

1. Ugwu JK, et al. Case Rep Oncol 10:720-25, 2017

2. Paraghamian SE, et al. Gynecologic Oncology Research and Practice 4:3, 2017