patients are reported to have died from distant metastases of ACC of the prostate [1]. A good prognosis has been described for ACC of the salivary gland, but ACC in other organs, e.g. the uterine cervix, has a poor prognosis and aggressive course [2,3]. ACC of Cowper's gland is extremely rare; only two cases have been reported [4,5]. The first survived 13 years after local resection and adjuvant radiotherapy, and pelvic exenteration with CASE REPORTA 52-year-old man was referred to our hospital for further examination of a rectal mass. He had first noticed the mass 3 years earlier but had had perineal pain for 8 years. A DRE showed a firm, tender mass underneath but separate from the prostate. His serum PSA level was 0.4 ng/mL; TRUS (Fig. 1A) and MRI (Fig. 1B) showed a mass extending inferiorly from the prostatic apex. Histology of a biopsy obtained under TRUS guidance showed basaloid cell nests with peripheral palisading surrounded by basophilic myxoid matrix. Basaloid tumour cells showed a cribriform arrangement surrounded by basophilic secretion, features consistent with adenoid cystic carcinoma (ACC) (Fig. 2). Immunohistochemically, the tumour cells did not stain for PSA, prostatic acid phosphatase, carcinoembryonic antigen, S-100 protein or smooth muscle actin, but were positive for high molecular-weight cytokeratin. A plain Xray and CT of the chest revealed several lung metastases, but bone scintigraphy and abdominal CT were negative. The patient received radiotherapy followed by two courses of chemotherapy (cisplatin and epirubicin), which resulted in a reduction of primary tumour size and amelioration of symptoms. However, the number and size of lung metastases did not change. Although the patient subsequently received several courses of cisplatin-based chemotherapy, the metastatic lung disease deteriorated gradually and the patient died 5 years after diagnosis; there was no autopsy. COMMENTCowper's glands are paired, pea-sized structures located within the urogenital diaphragm, which drain into the floor of the bulbous urethra. ACC is a relatively rare tumour and usually arises in salivary glands, and rarely in the nasopharynx, oral cavity, trachea, breast and prostate. Nineteen cases of ACC of the prostate have been reported and all were treated by surgical resection. Adjuvant radiotherapy, chemotherapy and hormone therapy have been used, although their effectiveness is controversial. Only two FIG. 1. a, Sagittal TRUS view, showing a mass (arrow) extending inferiorly from the prostatic apex. There is a hyperechoic mass compared with the prostate (arrow head), characterized by the presence of numerous tiny anechoic areas. b, The T2-weighted coronal image (TR = 3000, TE = 105) showed a mass (arrow) extending inferiorly from the prostatic apex. The high signal intensity area indicated a cystic component of the tumour (arrow head). a b
From 1972 to 1989, 21 patients underwent bladder replacement with sigmoid colon after cystectomy for bladder cancer. A portion of sigmoid colon (about 15 to 20 cm) was isolated and anastomosed to the urethral stump. Then the ureters were implanted in the sigmoid colon via submucosal tunnels. There were 20 men and 1 woman, ranging in age from 24 to 71 years (average 51 years). Preoperative investigations showed that all the cases were free of metastasis. Five years survival rate was 60.7% and there was no operative mortality. There was urethral recurrence in one case and in that case postoperative histopathology revealed carcinoma in situ with tumor. All patients were able to void by themselves without any difficulty. Five patients complained mild incontinence at daytime and all patients had mild incontinence during deep sleep at night, but all of them could maintain their normal daily life like before. The major postoperative complications were: leak at the site of anastomosis (between sigmoid colon and urethra) in 6 cases, hydronephrosis in 2 cases, VUR in 2 cases and bladder stone in 1 case. The patients who underwent bladder replacement with sigmoid colon were well satisfied, because there were no external stoma and the patients could void by themselves. From now, we want to improve our operative method in order to avoid postoperative incontinence.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.