Prostate cancer arising in ectopic prostatic tissue within the left seminal vesicle: a rare case diagnosed with multi-parametric magnetic resonance imaging and magnetic resonance imaging-transrectal ultrasound fusion biopsy
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Benign ectopia of prostatic glandular tissue in the seminal vesicles is rare with only three prior cases reported in the literature. Prostate cancer, arising within prostatic ectopia in the seminal vesicles, has never been described and therefore presents a challenge in both diagnosis and management.
Herein, we report a rare case of prostatic adenocarcinoma in ectopic prostate tissue in the left seminal vesicle, without evidence of prostatic glandular involvement. This case was diagnosed on multi-parametric magnetic resonance imaging and confirmed with magnetic resonance imaging-transrectal ultrasound fusion biopsy.
Awareness of this unusual phenomenon is significant because of the potential occurrence of malignancy to arise in unexpected, extra-glandular locations, which are not routinely sampled on routine transrectal ultrasound biopsy. However attention to lesions with characteristic multi-parametric magnetic resonance imaging features of prostate cancer, regardless of extra-glandular location, will help direct tissue sampling, facilitate a timely diagnosis and ensure appropriate management.
KeywordsApparent Diffusion Coefficient Benign Prostatic Hyperplasia Seminal Vesicle TRUS Biopsy Benign Prostatic Tissue
apparent diffusion coefficient
benign prostatic hyperplasia
external beam radiation therapy
An 80 year-old male, with a past medical history of benign prostatic hyperplasia (BPH), presented to Urology with a rising serum prostate specific antigen (PSA) level of 13.1 ng/mL. In 2008 and again in 2012, the patient underwent two 12-core TRUS biopsies, which yielded negative results. Given his rising PSA level, the patient subsequently underwent diagnostic multi-parametric prostate MR imaging to localize any potentially malignant lesions that may have been missed on biopsies.
Tissue histology from the repeat 14-core biopsies revealed benign prostatic tissue in all prostate gland sextants (12 cores), particularly in the left prostate base (3 total cores). However core biopsies of the lesion in the left seminal vesicle revealed both malignant and benign prostatic tissue.
While the phenomenon of ectopic prostatic glandular tissue in the genitourinary tract is rare, it is not entirely uncommon. While the majority of cases of benign prostatic ectopia have been reported in the urinary bladder [1, 2] and urethra , cases have also been described in the retro-vesicular space [4, 5], seminal vesicles [6, 7, 8], epididymis , testis , and rectum . Cancer arising in prostatic ectopia has only been reported four times in the literature, all in the urinary bladder and urethra [12, 13, 14, 15]. However we report a case of primary prostate adenocarcinoma arising in the seminal vesicle, without glandular or trans-capsular involvement, which to our knowledge, has never been described.
Due to its infrequency, malignancy arising within prostatic ectopia in the seminal vesicles has never been described and therefore presents a challenge in both diagnosis and management. Awareness of this unusual phenomenon is significant because of the potential occurrence of malignancy to arise in unexpected, extra-glandular locations, which are not routinely sampled on routine transrectal ultrasound biopsy. However attention to lesions with characteristic multi-parametric magnetic resonance imaging features of prostate cancer, regardless of extra-glandular location, will help direct tissue sampling, facilitate a timely diagnosis and ensure appropriate management.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
The authors have no acknowledgments.
The authors received no funding.
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