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A 58-year-old male patient, complaining of dysuresia, which increased over a period of 2 months, had a history of urine retention that did not respond to treatment administered in an outpatient clinic. Upon admission to the hospital on August 2, 2005, examination showed that his prostate was midrange size by rectal palpation, and without pain or prostate nodus. An ultrasound examination indicated the prostate size was 6.1 cm×4.7 cm×3.6 cm, without an occupying lesion in the prostate. Cystography showed obstructive cystitis protruding into the bladder. Both blood and urine tests were normal, with a PSA value of 3.47 ng/ml. The patient was diagnosed as benign prostate hyperplasia (BPH), and was treated by transurethral vaporization of the prostate (TUVP).
Examination of pathological sections showed that the tumor cells were characterized by abundant foamy xanthomatous cytoplasm, small nuclei and few prominent nucleoli (Fig.1). The shape of the neoplastic cells was tabular, like xanthoma cells, eosinophilic staining, without obvious nuclear heteromorphism or entoblast. Myoepithelial cells were not found around the gland alveolus, but were occasionly mingled with stroma, and different from classical prostatic carcinoma. Immunohistochemistry failed to identify CK34βE12 and P63 antigens, but PSA and cytokeratin were positive. The tumor was diagnosed as prostatic foamy adenocarcinoma by its pathohistology. The patient was treated with testicle resection and endocrine therapy. His blood PSA level has been regularly rechecked and symptoms of dysuresia have not recurred.
Prostatic foamy adenocarcinoma with abundant foamy xanthomatous cytoplasm(H&E×100).
CONCLUSION
Prostatic foamy adenocarcinoma or xanthoma of adenocarcinoma of the prostate, was described by Neleson and Epstein in 1996[1]. In 2001 Tran et al[2] reported that prostatic foamy adenocarcinoma was a rare high-grade aggressive prostatic malignancy that causes symptoms of bladder outlet obstruction. The pathologic character included a small acinar structure, aggressive development, no basilar membrane and negative results for CK34βE12 and P63[3]. It is easily misdiagnosed as benign prostatitis with small nuclei and few prominent nucleoli. This tumor should be distinguished from such diseases as prostatic carcinoma, xanthoma, sclerosing adenosis and vacuole degeneration of the prostate after radiotherapy or endocrine therapy.
- Received February 13, 2007.
- Accepted April 6, 2007.
- Copyright © 2007 by Tianjin Medical University Cancer Institute & Hospital and Springer
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