Primary Seminal Vesicle Adenocarcinoma Presenting as Acute Urinary Retention and Hematuria: A Case Report

Abstract

Primary tumors of the seminal vesicle are extremely rare lesions, and adenocarcinoma is the most common histology found. We report the case of a 54-year-old patient who has consulted with a bladder outlet obstruction and two episodes of initial hematuria for 3 months. Digital rectal examination revealed a hard, palpable mass in the prostate wall. The prostate-specific antigen (PSA), the serum carcinoembryonic antigen and the cancer antigen 125 (CA125) were normal. On imaging, a prostatic abscess, granulomatous prostatitis or a prostatic cancer were highly suspected at first. But the patient was afebrile and PSA was normal. Transrectal ultrasound-guided biopsies of the mass were performed. The pathological examination showed a poorly differentiated adenocarcinoma. Immunohistological analysis was strongly suggestive of adenocarcinoma of the seminal vesicle. At surgical exploration, it was impossible to make cystoprostato-vesiculectomy because the tumor was locally advanced. We decided to make hormonal blockage by antiandrogen and five sessions of radiotherapy. Unfortunately, the patient died 5 months later. Adenocarcinoma of the seminal vesicles is a rare diagnosis. We must think in this diagnosis when relatively young patient is presented with dysuria, hematuria or hemospermia and when we found hard palpable mass on digital rectal examination associated to normal PSA level. On histology, specific immunohistochemical markers would be helpful in this differential diagnosis. Actually, surgical excision is the mainstay of the treatment. Radiotherapy and androgen deprivation therapy can be an alternative in locally advanced and metastatic carcinomas.




World J Nephrol Urol. 2015;4(3):242-246
doi: http://dx.doi.org/10.14740/wjnu204e