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Endometrial Carcinoma of the Prostatic Utricle
Vol. 112. October Printed in
THE JOlJRNAL OF UROLOGY
Copyright © 1974 hy The Williams ll, Wilkins Co.
ENDOMETRIAL CARCINOMA OF THE PROSTATIC UTRICLE ERBY J. SATTER
AND
CHARLES M. BLUMENFELD
From the Department of Surgery, Section of Urology and Department of Pathology, Sutter General Hospital, Sacramento, California
In 1963 Ende and associates observed that cer- 1973 because of intermittent, painless hematuria. tain tumors arising in the area of the prostatic The bleeding had been progressive over a of utricle seemed to have a unique behavioral 9 months. The blood was seen during urination pattern. 1 These malignancies demonstrated a cel- also was observed on the pajamas in the lular variation which seemed to include a transi- prior to voiding. Related symptoms included diffi tional cell and adenocarcinoma cell mixture. They culty starting the stream, pain in both testicles, a were observed to metastasize rather slowly. The noticeable decrease in the amount of ejaculate and acid phosphatase levels were usually normal and a marked increase in libido. The patient stated the lesions did not usually respond to the orchiec- that he had become sexually active at least :3 times tomy and stilbestrol therapy. In 1967 Melicow and daily for the last 6 months. This man had been in Pachter examined a 50 gm. prostate gland enu- excellent health all his life, having had no cleated by supra pubic prostatectomy. 2 In the area illnesses and no prior operations. Physical examination was not remarkable. The of the prostatic utricle they found a concentration of malignant cells resembling endometrial car- urine was grossly bloody. An excretory urogram cinoma of the uterus. Their case was the first to was normal. At cystoscopy the bladder demonbe reported as an endometrial carcinoma of the strated early trabeculation. The ureteral orifice,: prostatic utricle. After this initial publication Meli- were normal. On inspection of the prostatic fossa cow and Tannenbaum found 5 additional cases. 3 there was immediately seen a dull, fibrinous They theorized that these tumors were derived coated polypoid mass completely replacing the from mi.illerian duct remnants localized in the verumontanum. The tumor appeared to be on epithelium of the verumontanum. Their article pedicle and prolapsed into the membranous ure provides extensive description of the probable thra. The mass was pushed back into the origin and the characteristic pathology of this neo- urethra with a resectoscope loop and resection plasm. Since that time 4 additional cases have biopsy was completed. been reported. 4 - 7 The Carney and KeREVIEW OF PATHOLOGY lalis makes further distinctions regarding the histopathological characteristics of adenocarThis case was then carefully studied by our cinoma of the prostate, carcinoma of the prostatic senior pathologist M. B.). Sections were alw ducts and endometrial carcinoma. Herein we re- sent to Dr. Meyer Melicow for review. 8 Blurnenfe!d port a case of a neoplasm originating in the veru- noted that the prostatic utricle is a montanum and review the characteristics of this remnant of the caudal end of the fused mtillerian rather anachronistic tumor. ducts homologous to the cervix and of the body of the uterus. Hypertrophy and CASE REPORT of the stratified squamous epithelium, of the A 51-year-old married man and father of 3 utriculus in men receiving estrogen is children was referred for examination on July 24, with the derivation of this structure and its retention of cell receptors comparable to correAccepted for publication May 31, 1974. 1 Ende, N., Woods, L. P. and Shelley, H. S.: Carcisponding parts of cells of the uterus in the female noma originating in ducts surrounding the prostatic ure- subject. This observation furnishes the backthra. Amer. J. Clin. Path., 40: 183, 1963. ground for Melicow and Pachter's case reports. 2 2 Melicow, M. M. and Pachter, M. R.: Endometrial Possibilities of neoplasms in the vicinity of the carcinoma of prostatic utricle (uterus masculinus). Canverumontanum include transitional cell 20: 1715. 1967. M. M. and Tannenbaum, M.: Endometrial cinoma, squamous cell carcinoma, carcinoma of carcinoma of uterus masculinus (prostatic utricle). Re- the prostatic utricle and carcinoma of the port of 6 cases. J. Urol., Hl6: 892, 1971. tory ducts. Dube and associates recently reviewed 4 Belter, L. F. and Dodson, A. I., Jr.: Papillomatosis and papillary adenocarcinoma of the prostatic ducts: a 4,286 cases of adenocarcinoma and identified 55 case report. J. Urol., 104: 880, 1970. cases as ductal in origin. They further Dube, . E., Joyce, G. T. and Kennedy, E.: Papillary the latter group into primary and secondary ductal primary duct adenocarcinoma of the prostate. J. Urol., carcinoma. Histologically, adenocarcinoma Hl7: 825, 1972. 6 Young, B. W. and Lagios, M. D.: Endometrial from the primary ducts show exuberant (papillary) carcinoma of prostatic utricle. Personal com- fronds covered by simple, tall, columnar munication. lium, with basically placed uniform nuclei and 7 5
Carney, J. and Kelalis, P. P.: Endometrial carcinoma of the prostatic utricle. Amer. J. Clin. Path., 60: 565,
'Melicow, M. M.: Personal communication.
197:3.
505
506
SATTER AND BLUMENFELD
pale eosinophilic cytoplasm. Adenocarcinoma of the secondary ducts show fewer chromatic nuclei. In our case there were few papillae, none covered by tall, simple, columnar epithelium with even, regularly placed nuclei and general lighter eosinophilic cytoplasm and larger, more pleomorphic nuclei and nucleoli. For these reasons this lesion is interpreted as derived from prostatic gland ducts rather than prostatic utricle. Melicow's written report agreed. 8 SUMMARY
Melicow described a new type of prostatic malignancy derived from endometrium. The embryological derivation from the prostatic utricle forms the solid basis for this concept. There is only one major distinguishing characteristic of this tumor which is
the presence of cilia. These cilia occur in the neoplastic endometrial epithelium and are completely absent in the neoplastic prostatic epithelium. Of the 10 cases reported the average patient age was 68 years. All 10 patients had urinary tract obstruction and 7 had gross hematuria. The acid and alkaline phosphatase levels were not elevated. Treatment in these 10 cases included 3 resections by transurethral route, 3 suprapubic prostatectomies, 3 radical prostatectomies and 1 palliative radiation. In some cases a combined approach was used of transurethral resection followed by radical prostatectomy. Prognosis for this tumor can be favorable. Six of the 10 patients are free of tumor. X-ray therapy is the treatment of choice for palliation. Orchiectomy and/or stilbestrol would appear to be contraindicated.
THE JOlJRNAL OF UROLOGY
Copyright © 1974 hy The Williams ll, Wilkins Co.
ENDOMETRIAL CARCINOMA OF THE PROSTATIC UTRICLE ERBY J. SATTER
AND
CHARLES M. BLUMENFELD
From the Department of Surgery, Section of Urology and Department of Pathology, Sutter General Hospital, Sacramento, California
In 1963 Ende and associates observed that cer- 1973 because of intermittent, painless hematuria. tain tumors arising in the area of the prostatic The bleeding had been progressive over a of utricle seemed to have a unique behavioral 9 months. The blood was seen during urination pattern. 1 These malignancies demonstrated a cel- also was observed on the pajamas in the lular variation which seemed to include a transi- prior to voiding. Related symptoms included diffi tional cell and adenocarcinoma cell mixture. They culty starting the stream, pain in both testicles, a were observed to metastasize rather slowly. The noticeable decrease in the amount of ejaculate and acid phosphatase levels were usually normal and a marked increase in libido. The patient stated the lesions did not usually respond to the orchiec- that he had become sexually active at least :3 times tomy and stilbestrol therapy. In 1967 Melicow and daily for the last 6 months. This man had been in Pachter examined a 50 gm. prostate gland enu- excellent health all his life, having had no cleated by supra pubic prostatectomy. 2 In the area illnesses and no prior operations. Physical examination was not remarkable. The of the prostatic utricle they found a concentration of malignant cells resembling endometrial car- urine was grossly bloody. An excretory urogram cinoma of the uterus. Their case was the first to was normal. At cystoscopy the bladder demonbe reported as an endometrial carcinoma of the strated early trabeculation. The ureteral orifice,: prostatic utricle. After this initial publication Meli- were normal. On inspection of the prostatic fossa cow and Tannenbaum found 5 additional cases. 3 there was immediately seen a dull, fibrinous They theorized that these tumors were derived coated polypoid mass completely replacing the from mi.illerian duct remnants localized in the verumontanum. The tumor appeared to be on epithelium of the verumontanum. Their article pedicle and prolapsed into the membranous ure provides extensive description of the probable thra. The mass was pushed back into the origin and the characteristic pathology of this neo- urethra with a resectoscope loop and resection plasm. Since that time 4 additional cases have biopsy was completed. been reported. 4 - 7 The Carney and KeREVIEW OF PATHOLOGY lalis makes further distinctions regarding the histopathological characteristics of adenocarThis case was then carefully studied by our cinoma of the prostate, carcinoma of the prostatic senior pathologist M. B.). Sections were alw ducts and endometrial carcinoma. Herein we re- sent to Dr. Meyer Melicow for review. 8 Blurnenfe!d port a case of a neoplasm originating in the veru- noted that the prostatic utricle is a montanum and review the characteristics of this remnant of the caudal end of the fused mtillerian rather anachronistic tumor. ducts homologous to the cervix and of the body of the uterus. Hypertrophy and CASE REPORT of the stratified squamous epithelium, of the A 51-year-old married man and father of 3 utriculus in men receiving estrogen is children was referred for examination on July 24, with the derivation of this structure and its retention of cell receptors comparable to correAccepted for publication May 31, 1974. 1 Ende, N., Woods, L. P. and Shelley, H. S.: Carcisponding parts of cells of the uterus in the female noma originating in ducts surrounding the prostatic ure- subject. This observation furnishes the backthra. Amer. J. Clin. Path., 40: 183, 1963. ground for Melicow and Pachter's case reports. 2 2 Melicow, M. M. and Pachter, M. R.: Endometrial Possibilities of neoplasms in the vicinity of the carcinoma of prostatic utricle (uterus masculinus). Canverumontanum include transitional cell 20: 1715. 1967. M. M. and Tannenbaum, M.: Endometrial cinoma, squamous cell carcinoma, carcinoma of carcinoma of uterus masculinus (prostatic utricle). Re- the prostatic utricle and carcinoma of the port of 6 cases. J. Urol., Hl6: 892, 1971. tory ducts. Dube and associates recently reviewed 4 Belter, L. F. and Dodson, A. I., Jr.: Papillomatosis and papillary adenocarcinoma of the prostatic ducts: a 4,286 cases of adenocarcinoma and identified 55 case report. J. Urol., 104: 880, 1970. cases as ductal in origin. They further Dube, . E., Joyce, G. T. and Kennedy, E.: Papillary the latter group into primary and secondary ductal primary duct adenocarcinoma of the prostate. J. Urol., carcinoma. Histologically, adenocarcinoma Hl7: 825, 1972. 6 Young, B. W. and Lagios, M. D.: Endometrial from the primary ducts show exuberant (papillary) carcinoma of prostatic utricle. Personal com- fronds covered by simple, tall, columnar munication. lium, with basically placed uniform nuclei and 7 5
Carney, J. and Kelalis, P. P.: Endometrial carcinoma of the prostatic utricle. Amer. J. Clin. Path., 60: 565,
'Melicow, M. M.: Personal communication.
197:3.
505
506
SATTER AND BLUMENFELD
pale eosinophilic cytoplasm. Adenocarcinoma of the secondary ducts show fewer chromatic nuclei. In our case there were few papillae, none covered by tall, simple, columnar epithelium with even, regularly placed nuclei and general lighter eosinophilic cytoplasm and larger, more pleomorphic nuclei and nucleoli. For these reasons this lesion is interpreted as derived from prostatic gland ducts rather than prostatic utricle. Melicow's written report agreed. 8 SUMMARY
Melicow described a new type of prostatic malignancy derived from endometrium. The embryological derivation from the prostatic utricle forms the solid basis for this concept. There is only one major distinguishing characteristic of this tumor which is
the presence of cilia. These cilia occur in the neoplastic endometrial epithelium and are completely absent in the neoplastic prostatic epithelium. Of the 10 cases reported the average patient age was 68 years. All 10 patients had urinary tract obstruction and 7 had gross hematuria. The acid and alkaline phosphatase levels were not elevated. Treatment in these 10 cases included 3 resections by transurethral route, 3 suprapubic prostatectomies, 3 radical prostatectomies and 1 palliative radiation. In some cases a combined approach was used of transurethral resection followed by radical prostatectomy. Prognosis for this tumor can be favorable. Six of the 10 patients are free of tumor. X-ray therapy is the treatment of choice for palliation. Orchiectomy and/or stilbestrol would appear to be contraindicated.