An Unusual Cystic Presentation of Ductal Carcinoma of the Prostate

Abstract

A 74-year-old male came to our clinic for rectal tenesmus, lower urinary tract symptoms and a previous episode of acute retention of urine. Computed tomography (CT) and magnetic resonance imaging (MRI) scan of abdomen showed a multiloculated, cystic formation of 12 cm in the pelvic cavity to the left, with compression of the prostate, bladder, sigmoid and rectum, and its extension imprinted the back of the pubis and back bladder. Saturation prostate biopsy was negative for carcinoma. The histology of transurethral resection of bladder formation revealed flogistic tissue. Cistoprostatectomy and ureteroileal pouch with Wallace anastomosis, removal of the rectum and colostomy with Hartmann pouch were performed. The histopatology showed a ductal carcinoma of the prostate.

MRI Finding of Prostatic Ductal Adenocarcinoma

“…There have been little reports demonstrating the MRI features of prostatic ductal adenocarcinoma. Two groups [ 3 , 4 ] have demonstrated the multiloculated cystic formation around the prostate and the bladder, similar to our series. Prostate cancer with cystic formation is classified into 2 groups [ 3 ].…”

“…In the initial stages, ductal adenocarcinoma presents as a cystic growth pattern, which was suggested to be due to occlusion of the prostatic duct and induction of cystic dilation because of its distinctive site of growth. Most of those ductal adenocarcinoma cases tended to present as a papillary growth pattern that developed into a large cyst, which is termed “papillary cystadenocarcinoma of the prostate.” De Gobbi et al [ 4 ] demonstrated that the differential diagnosis should therefore take into consideration giant multilocular prostatic cystadenoma, adenoid cystic adenoma and cystadenocarcinoma of the prostate, seminal vesicle cysts or cystic tumor, sarcoma, cystic teratoma, cystic lymphangioma, cystic mullerian duct abnormality, cystic peritoneal mesothelioma, mesenteric cyst, Tarlov cyst, enteric abscess, and echinococcosis. Other groups have a noncystic pattern on MRI [ 6 , 7 ].…”

“…Pure ductal adenocarcinoma accounts for 0.4–0.8% of all prostate cancers, whereas mixed acinar and ductal adenocarcinoma accounts for 5% of all prostate cancers [ 1 , 2 ]. Its presentation could be an exophytic endourethral lesion, and most of it tended to present as a papillary growth pattern that developed into a large cyst [ 3 , 4 ]. We discuss magnetic resonance imaging (MRI) features of prostatic ductal adenocarcinoma.…”

“…Ductal adenocarcinoma is the most common of the variants of prostatic adenocarcinoma, originating from the epithelial lining of the primary and secondary ducts of the prostate, with unique clinical and pathologic features. Pure ductal adenocarcinoma accounts for 0.4-0.8% of all prostate cancers, whereas mixed acinar and ductal adenocarcinoma accounts for 5% of all prostate cancers [1, Its could be an exophytic endourethral lesion, and most of it tended to present as a papillary growth pattern that developed into a large cyst [3,4]. We discuss magnetic resonance imaging (MRI) features of prostatic ductal adenocarcinoma.…”

Differential diagnosis of uncommon prostate diseases: combining mpMRI and clinical information

“…However, in a few cases, ductal adenocarcinoma with/without acinar adenocarcinoma presents with a cystic/multicystic growth pattern (Fig. 8 ), which is due to occlusion of the prostatic duct and induction of cystic dilation, intracancerous tissue hemorrhage or central necrosis of the cancer tissue [ 36 , 37 ]. The presence of cysts with thick walls or mural nodules with restricted diffusion may be malignant signs distinguishing them from cystadenoma.…”