Adenoid cystic carcinoma of Cowper's gland

Abstract

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

Giant multicystic cystadenoma of Cowper's gland: a case report

“…On imaging techniques (MRI) they appear as small cystic lesions (14); treatment consists of endoscopic incision. Tumors arising from these glands are extremely rare; only 20 cases of adenocarcinomas have been reported and only four had a cystic component (15)(16)(17).…”