Transperitoneal laparoscopic treatment for recurrence of a giant multilocular prostatic cystadenoma: A case report and review of the literature

Abstract

Giant multilocular prostatic cystadenomas (GMPC) are very rare benign tumors that originate from the prostate with extensive spread into the pelvis. The lesion may present as large abdominal mass causing obstructive voiding dysfunction and usually not invading adjacent structures. All of the previously reported patients with GMPC underwent open surgery. Although the natural history of prostatic cystadenoma remains unknown, complete surgical excision may not always be necessary. We report the case of a 74-year-old male who presented a retrovesical recurrence of prostatic cystoadenoma after 16 years, treated with a laparoscopic approach. To our knowledge this is the first case of laparoscopic management of GMPC. In this article we review the current literature about this rare tumor and discuss the diagnostic and management dilemmas posed by this rare pathologic condition. We believe that physicians should at least be aware of the existence of this disease in the differential diagnosis of pelvic cavity tumours and, considering the benignity of GMPC, they should propose--as first--a minimally invasive approach.

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

“…In a review of the previous literature on such cases, several treatment modalities for giant multilocular prostatic cystadenoma have been reported, including conservative treatment such as gonadotropin-releasing hormone (GnRH) antagonist[ 12 ], transurethral resection[ 13 ] or enucleation of the prostate, laparoscopic cyst resection[ 14 ], partial or complete tumor resection, even radical prostatectomy or pelvic exenteration. For now, the general consensus of management is complete surgical excision.…”

“…Only one study reported that a GnRH antagonist was effective for the treatment of recurrent GMC of the prostate, and it was not feasible for that patient to undergo invasive surgery. Nonetheless, no recurrences were reported during the different follow-up periods reported in patients who underwent TURP[ 13 ] and cyst resection[ 14 ]. Furthermore, in most known situations, incomplete resection could result in recurrence despite the benign nature of the tumor.…”

“…Our limited experience with treatment options in cases of such rare tumors may confine our treatment choice. Only one article has reported a minimally invasive approach with transperitoneal laparoscopic resection of cysts without complete tumor excision[ 14 ]. With the advancement of medical technology, robotic surgery has become more popular thanks to its clear three-dimensional visualization, navigation, and precise operation.…”

Imaging and clinical features of giant multilocular prostatic cystadenoma

“…[ 11 ] Occasionally, constipation caused by mechanical compression of the rectum can be seen. [ 8 ] These manifestations are suggestive of a lower urinary tract disease but not specific, similar to the features of prostate hyperplasia. Elevated serum PSA is commonly seen in most patients.…”

“…However, CT or MRI might reveal components of the tumor and its relationship with adjacent organs, which is crucial for the optimal determination of surgical procedure. [ 8 ] GMPC is often characterized with multilocular masses in the pelvis. The septa in the cyst are often irregularly thickened.…”