賴宗豪¹、林克勳¹、許軒豪¹

¹臺北市立萬芳醫院 泌尿科

Chung-Howe Lai¹, Ke-Hsun Lin¹, Syuan-Hao Syu¹

¹Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

 

Schwannomas are rare tumors originated from the schwann cell of the peripheral nerve sheaths, generally occurring in young and middle-aged adults, and sometimes related to inheritable disorders, such as neurofibromatosis type 1. The most common locations include head, neck, extremities, mediastinum and retroperitoneum but very rarely the male genital system. Herein, we report a case of a 65-year-old man who was thought to be either a benign prostate hyperplasia (BPH) or prostate cancer patient, initially presented with elevated PSA level (up to 12ng/ml). Lower urinary tract symptoms (LUTS) were mild. Digital rectal examination revealed a grade 3 enlarged prostate with a palpable left side hard nodule. Transrectal ultrasonography (TRUS) revealed estimated prostate volume 61.2cm³ and a hypoechoic nodule over left lateral lobe. Biopsy revealed a spindle cell tumor with alternating cellularity, and immunohistochemically positive for S-100, validating a schwannoma of the prostate. BPH but no cancer was found in all other biopsied sections. Magnetic resonance imaging confirmed the mass in the prostate and showed no evidence of local extension or other lesions elsewhere. Due to mild symptoms presentation, the patient was not operated on. Neither tumor enlargement, further elevated PSA nor worsening of LUTS were found during a total follow up period of 6 years up to date. Despite previous literature often suggesting surgery for these rare tumors, active surveillance seems to be a feasible treatment choice for patients with a schwannoma of the prostate without bothersome symptoms.