Giant multilocular prostatic cystadenoma

Abstract

Background The giant multilocular prostatic cystadenoma is a very rare benign tumor of the prostate gland. It is composed of predominantly cystic enlarged prostatic glands in a fibrous stroma and spreads extensively into the pelvis. Because of the large size at the time of diagnosis, it is not always possible to determine the exact point of origin for these multilocular cystic neoplasms. Thus, diagnosis before histological examination of a surgical specimen is often difficult. Here, we present a case involving one of the largest giant multilocular prostatic cystadenomas reported in the literature and discuss preoperative diagnoses and appropriate surgical approaches for this rare retroperitoneal tumor. Case presentation A 50-year-old man presented with a 2-year history of abdominal distension and lower urinary symptoms. Enhanced CT showed a large retroperitoneal mass with multiple septations in the pelvis and lower abdomen, measuring 30 cm in size, surrounding the rectum and displacing the bladder, prostate, and seminal vesicle to the right anterior side. MRI showed multiple cysts with a simple fluid appearance on T2-weighted images and enhanced solid components on gadolinium-enhanced fat-saturated T1-weighted images, suggesting the retroperitoneal mass as leiomyoma with cystic degeneration or perivascular epithelioid cell tumor. Biopsy of the mass showed a spindle cell tumor with focal smooth muscle differentiation. Differential diagnosis comprising leiomyoma, low-grade leiomyosarcoma, and perivascular epithelioid cell tumor was made. Complete resection of the tumor with low anterior resection of the rectum was performed. The tumor was solid with multilocular cavities containing blackish-brown fluid and measured 33 × 23 × 10 cm. Histologically, the tumor was composed of variously sized dilated glandular structures lined by prostatic epithelia surrounded by fibromuscular stroma. The prostatic nature of the lesions was confirmed by immunohistochemical staining of the epithelium for prostate-specific antigen. Thus, pathological diagnosis was a giant multilocular prostatic cystadenoma. Conclusions We present our experiences with one of the largest giant multilocular prostatic cystadenomas. When a retroperitoneal huge lesion with locular cavities fills the pelvis in a male patient, the possibility of giant multilocular prostatic cystadenoma should be considered before planning for retroperitoneal tumor treatment.

Prostatic cystadenoma presenting as a large multilocular pelvic male mass

“…The clinical presentation in all patients is similar to benign prostatic hyperplasia with frequently lower urinary tract symptoms [ 1–3 ]. Other symptoms like defecation problems may occult the urinary symptoms due to rectal compression by the mass [ 2 ].…”

Imaging and clinical features of giant multilocular prostatic cystadenoma

“…It is characterized by significantly enlarged prostatic cystadenoma, most of them are larger than 10 cm in size (about 68% in the literature). [ 2 – 15 ] In this condition, the tumor always originates from the prostate and extends to the space between the rectum and bladder, sometimes it may attach to the prostate with pedicle or even be completely separated from it. The tumor boundary is usually clear without invasion to the adjacent tissues and organs.…”

“…This case is consistent with previous reports. [ 2 , 7 , 9 ] No atypical cell proliferation or mitosis was recognized. Immunohistochemical analysis showed the tumor cells were positive for PSA and PSAP staining, indicating a prostatic origin.…”

Robotic surgery in giant multilocular cystadenoma of the prostate: A rare case report

“…Giant multilocular cystadenomas (GMC) are extremely rare benign tumors that originate in the prostate, less frequently in the seminal vesicles[ 1 ] and Cowper’s glands[ 2 ]. So far, there are still no more than 30 cases reported, according to our latest review[ 3 ]. It can occur at any age; the age of patients ranges from 23[ 4 ] to 80 years[ 5 ].…”