Perivascular epithelioid cell tumor (PEC-ome) of the prostate: Ultrasound feature in case report

Introduction: We describe a rare tumor arising from the prostate gland: Perivascular Epithelioid Cells tumor (PEC-ome). A 54-years old was treated for acute urinary retention with alpha-blockers at presentation due to benign prostate enlargement (65 cc) with asymmetric middle lobe and regular PSA (0.92 ng/ml). After 5 months, patient developed a second acute urinary retention episode and nodules in the left lung; he was treated with transurethral resection of the prostate and left lobectomy. Results: Histological examination of prostate and lung tissue gave the same diagnosis: leiomyosarcoma with atypical morphological features and patient was observed for 4 months. Considering the uncommon diagnosis, pathological review by the uro-pathologist at our Hospital was done. Additional immunohistochemistry was done and both tumors showed similar and typical features of metastatic PEC-ome (T1b N0 M1). Therefore a new staging showed local and distant progression with prostatic mass and small lung metastasis. Three cycles of Gemcitabine and Pazopanib were administered, but 2 months later a new urinary retention occurred, despite chemotherapy. Patient referred to our Hospital for salvage pelvic surgery with lymph node dissection. Final pathological diagnosis was PECome of the prostate stage pT4 pN0 R0 M1. Conclusions: PEC-ome is a rare but rapidly invasive mesothelial tumor with early metastatic potential. When this tumors originates from the fibromuscular stroma of the prostate it mimics benign prostatic enlargement and causes LUTS. Expert pathology aided by immunoisthochemistry is the cornerstone of diagnosis. There are no pathognomonic imaging on ultrasound or symptoms suggesting the presence of PECome in early stage. A multidisciplinary approach is necessary and radical surgery should be done to treat this aggressive cancer.

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A clinico pathological study and management of benign enlargement of prostate

International Surgery Journal ◽

10.18203/2349-2902.isj20180992 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1275 ◽

Cited By ~ 1

Author(s):

Ashish Mor ◽

Surender Mohan Sharma ◽

Sujoy Mukherjee ◽

Rishi Jindal

Keyword(s):

Urinary Retention ◽

Acute Urinary Retention ◽

Prostate Volume ◽

Stone Formation ◽

Prostate Gland ◽

Digital Rectal Examination ◽

Pathological Study ◽

Significant Relation ◽

Residual Urine ◽

Severe Group

Background: Benign prostatic hyperplasia (BPH) is the non-malignant enlargement of the prostate gland. Prolonged obstructions may eventually lead to acute urinary retention, recurrent urinary tract infection, hematuria, bladder calculi, and renal insufficiency.Methods: Hundred cases of benign enlargement of prostate were studied from November 2015 to 2016. Patients diagnosed as benign enlargement of prostate by clinical digital rectal examination, investigation like USG were included in this study. Patients with urinary retention due to strictures and urolithiasis, carcinoma were excluded.Results: Mean age of presentation was 64.4, and 34% were found to be in severe group of IPSS grading. There was a significant co-relation between the PVRU and prostate volume. There were 16% cases of acute urinary retention, 2% cases presented with bladder stones. Benign enlargement of prostate, IPSS score, Post voidal residual urine has a weak correlation with the increasing age as observed.Conclusions: Benign enlargement of prostate is a disease of elderly with peak incidence in the 5th and 6th decade of life, BPH has co-relation with inguinal hernia, AUR which is 16%. There was no correlation between the age of the patient and the severity of symptoms with respect to IPSS score. There was no correlation between the age of the patient and the severity of symptoms with respect to IPSS score. In present study there was a statistically significant relation were found between prostate volume and post voidal residual urine. Large amount of residual urine is the indication for surgery because it predisposes to infections and stone formation.

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Vesical Gossypiboma with Urethral Migration Causing Acute Urinary Retention: A Case Report and Review of the Literature

10.21203/rs.3.rs-1223212/v2 ◽

2022 ◽

Author(s):

Kaleab Habtemichael Gebreselassie ◽

Ferid Ousman Mummed ◽

Fitsum Gebreegziabher Gebrehiwot ◽

Mubarek Bargicho Adem ◽

Ramzi Yessuf Adem ◽

...

Keyword(s):

Urinary Retention ◽

Acute Urinary Retention ◽

Treatment Options ◽

Pelvic Surgery ◽

Surgical Removal ◽

Diagnostic Challenge ◽

Surgical Sponge ◽

Retained Surgical Sponge ◽

Patient Reported ◽

High Index Of Suspicion

Abstract Introduction: Vesical gossypiboma is a retained surgical sponge in the urinary bladder following abdominal or pelvic surgery. It is probably under-reported due to medico-legal issues. It usually poses a diagnostic challenge to clinicians. A high index of suspicion is essential to make a timely diagnosis. Case Presentation: We present a case of vesical gossypiboma in a 64-year-old male patient who presented with a history of persistent lower urinary tract symptoms (LUTS) and acute urinary retention following trans-vesical prostatectomy. The urinary retention was relieved by a suprapubic cystostomy. On cystoscopic examination, a large whitish spongiform structure in the urethra and bladder was revealed. A gentle attempt of cystoscopic removal was failed. At exploration, a retained surgical sponge was revealed and removed from the bladder. Postoperatively, the patient reported improvement of symptoms and was passing urine normally. Discussion Vesical gossypiboma is relatively rare as very few isolated cases have been reported, and its migration through the urethra is even rarer. Patients with intravesical gossypiboma may manifest with either acute or chronic symptoms due to complications. Gossypiboma is an avoidable condition, and its occurrence can be prevented by thorough exploration of the surgical site and count of surgical materials at the end of the procedure. Conclusion Vesical gossypiboma should be considered as a differential diagnosis in patients with persistent LUTS following open bladder or prostate surgery. Open surgical removal is one of the feasible treatment options. But prevention is a preferable solution.

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Malignant Perivascular Epithelioid Cell Tumor Mimicking Renal Cell Carcinoma: A Diagnostic Pitfall

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz113.061 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S62-S62

Author(s):

Natalya Hakim ◽

Yevgen Chornenkyy ◽

Shadi Qasem

Keyword(s):

Clear Cell ◽

Metastatic Potential ◽

Epithelioid Cell ◽

Initial Diagnosis ◽

World Health ◽

Epithelioid Cells ◽

Mesenchymal Tumors ◽

Fuhrman Grade ◽

Perivascular Epithelioid Cell ◽

Eosinophilic Cytoplasm

Abstract Introduction Perivascular epithelioid cell tumors (PEComas) are defined by the World Health Organization (WHO) as mesenchymal tumors arising from perivascular epithelioid cells with myomelanocytic immunophenotype. In the kidney, they are often referred to as epithelioid angimyolipoma (AML). Most are benign but some can be malignant. Their rarity and wide differential render diagnosis challenging. Case Presentation A 56-year-old male presented with a 3-month history of flank pain. Computed tomography (CT) identified bilateral necrotic heterogeneous enhancing kidney masses, with right significantly larger than left. Initially, the patient underwent a right radical nephrectomy. On gross examination, no tumor infiltration was observed. Histology demonstrated sheets of highly atypical cells with clear cytoplasm and easily identifiable nucleoli. Areas of spindle and rhabdoid differentiation were present. The initial diagnosis was renal clear cell (RCC) carcinoma, Fuhrman grade 4, with extensive rhabdoid and focal sarcomatoid features. A follow-up CT demonstrated a hypodense area within the right hepatic lobe. Status post liver resection and histomorphological examination, the lesion was identical to the renal mass except for focal areas of prominent epithelioid cells with eosinophilic cytoplasm. Immunohistochemical (IHC) stains of both masses were positive for Melan-A, HMB-45, and EMA but negative for PAX8, SOX10, S100, SMA, desmin, and cytokeratin. The initial diagnosis was amended to malignant AML with hepatic metastasis. Discussion and Conclusion Renal PEComa (epithelioid AML) is a rare tumor with a prevalence of 0.44%. While most are benign, some are malignant with metastatic potential. The differential diagnosis for PEComa is broad and includes more common tumors like RCC, melanoma, clear cell sarcoma, and liposarcoma. The presence of spindle and epithelioid histology with eosinophilic cytoplasm in RCC should prompt additional IHC workup (HMB45, Melan-A, SMA, and EMA) in order to exclude PEComa/AML.

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Vesical Gossypiboma with Urethral Migration Causing Acute Urinary Retention: A Case Report and Literature Review

10.21203/rs.3.rs-1223212/v1 ◽

2022 ◽

Author(s):

Kaleab Habtemichael Gebreselassie ◽

Ferid Ousman Mummed ◽

Fitsum Gebreegziabher Gebrehiwot ◽

Mubarek Bargicho Adam ◽

Ramzi Yesuf Adam ◽

...

Keyword(s):

Urinary Retention ◽

Acute Urinary Retention ◽

Treatment Options ◽

Pelvic Surgery ◽

Surgical Removal ◽

Diagnostic Challenge ◽

Surgical Sponge ◽

Retained Surgical Sponge ◽

Patient Reported ◽

High Index Of Suspicion

Abstract Introduction: Vesical gossypiboma is a retained surgical sponge in the urinary bladder following abdominal or pelvic surgery. It is probably under-reported due to medico-legal issues. It usually poses a diagnostic challenge to clinicians. A high index of suspicion is essential to make a timely diagnosis. Case Presentation: We present a case of vesical gossypiboma in a 64-year-old male patient who presented with a history of persistent lower urinary tract symptoms (LUTS) and acute urinary retention following trans-vesical prostatectomy. The urinary retention was relieved by a suprapubic cystostomy. On cystoscopic examination, a large whitish spongiform structure in the urethra and bladder was revealed. A gentle attempt of cystoscopic removal was failed. At exploration, a retained surgical sponge was revealed and removed from the bladder. Postoperatively, the patient reported improvement of symptoms and was passing urine normally. Clinical Discussion: Vesical gossypiboma is relatively rare as very few isolated cases have been reported, and its migration through the urethra is even rarer. Patients with intravesical gossypiboma may manifest with either acute or chronic symptoms due to complications. Gossypiboma is an avoidable condition, and its occurrence can be prevented by thorough exploration of the surgical site and count of surgical materials at the end of the procedure. Conclusion Vesical gossypiboma should be considered as a differential diagnosis in patients with persistent LUTS following open bladder or prostate surgery. Open surgical removal is one of the feasible treatment options. But prevention is a preferable solution.

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B-lymphocytic infiltration of the prostate to a patient with chronic lymphocytic leukemia. A case report

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2017.1.83 ◽

2017 ◽

Vol 89 (1) ◽

pp. 83

Author(s):

Ioannis Anastasiou ◽

Spyridon Skoufias ◽

Ioannis Katafigiotis ◽

Ioannis Skarmoutsos ◽

Constantinos A. Constantinides

Keyword(s):

Benign Prostatic Hyperplasia ◽

Chronic Lymphocytic Leukemia ◽

Urinary Retention ◽

Acute Urinary Retention ◽

Prostate Gland ◽

Lymphocytic Infiltration ◽

Prostatic Hyperplasia ◽

Lymphocytic Leukemia ◽

Urinary Tract Symptoms ◽

History Of

Involvement of the prostate gland, as an early extra-nodal manifestation of a hematologic disease, or as a secondary infiltration is rare. Even rarer is the acute urinary retention due to infiltration by lymphocytes and simultaneously enlarged prostate. We present a case of a 61 years old male patient with a history of chronic lymphocytic leukemia, who was under oncological follow-up with no active treatment and had typical lower urinary tract symptoms due to benign prostatic hyperplasia and was receiving 5-alpha reductase inhibitor. After an acute urinary retention episode which was managed with a suprapubic catheter due to urethral catheter insertion failure, the patient was submitted to a transurethral prostatectomy. Histological examination revealed lymphocytic infiltration of the prostatic parenchyma by mostly small B cells. B-lymphocytic infiltration of the prostate gland, causes symptoms similar to benign prostatic hyperplasia. Acute urinary retention due to B-lymphocytic infiltration of the prostate is rare and the diagnosis is always histological and an oncological re-evaluation is necessary. The prognosis of these patients is related to the generalized disease rather than to the prostatic involvement.

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