0022-534 7/85/1336-1038$02.00/0 Vol. 133, June
THE JOURNAL OF UROLOGY
Copyright© 1985 by The Williams & Wilkins Co.
Printed in U.S.A.
GRADE 2 URETHROPROSTATIC PAPILLARY UROTHELIAL
CARCINOMA WITH POSITIVE URINARY CYTOLOGY GIUSEPPE PASQUALE MINCIONE, VALERIO DI CELLO, LUCIANO NIGi, ANDREA DURVAL AND CARLO SALTUTTI From the Departments of Urology and Anatomic Pathology, University of Florence, Florence, Italy
A rare case of papillary urothelial grade 2 carcinoma of the prostate and urethra in a patient with a previous papillary neoplasm of the bladder is reported. The tumor caused hematuria and prostatic enlargement suspicious for cancer. Urinary cytology was diagnostic. We describe a patient with papillary urothelial grade 2 carcinoma of the prostate and positive urinary cytological findings. CASE REPORT
A 65-year-old man was hospitalized in September 1976 because of pollakiuria, dysuria and nocturia, and a 6-month history of hematuria. The patient had undergone fulguration of a papillary neoplasm of the bladder 16 years ago. Physical
cells, and with moderate nuclear enlargement and hyperchromatism. In some areas neoplastic cells showed large, irregularly shaped and highly hyperchromatic nuclei. Furthermore, solid areas with squamous neoplastic cells were observed (fig. 2). Diagnosis was papillary infiltrating urothelial carcinoma. The neoplasm was reclassified as grade 2 according to Koss. 1 The patient was followed in another hospital and died of diffuse metastases 3 years later.
FIG. 1. A, urinary cytological pattern shows neoplastic cells mostly elongated in shape, and mixed with erythrocytes and polymorphonuclear leukocytes. B, elongated cell with long tail and enlarged end. C, group of polygonal neoplastic cells. Filter preparation, Papanicolaou's stain, reduced from X500.
examination revealed an enlarged and hardened prostate, and malignancy was suspected. Urinary cytological examination revealed numerous urothelial cells mixed with some squamous cells, polymorphonuclear leukocytes and erythrocytes (fig. 1). The urothelial cells showed anisocytosis, and were isolated or arranged in small aggregates. Many cells appeared elongated and sometimes had a long tail with an enlarged end. The nuclei were anisokaryotic, sometimes enlarged markedly and hyperchromatic, which suggested a papillary urothelial neoplasm. Excretory urography and cystography showed enlargement of the prostate. Cystoscopic findings were negative. At operation no lesion was found in the bladder, while a papillary neoplasm was noted in the prostatic urethra. The neoplasm was resected and transvesical intracapsular prostatectomy was performed. Pathological examination of the surgical specimen revealed a well delineated whitish mass partly occupying the anterior half of the prostate and compressing the gland. Histologically, the papillary neoplasm partly replaced the prostatic tissue, and infiltrated the ducts and acini of the gland. The papillae were covered by more than 20 layers of urothelium with superficial Accepted for publication January 17, 1985.
In this patient with hematuria and a prostatic mass urinary cytology suggested the presence of a urothelial neoplasm. An operation and subsequent histological examination revealed that the neoplastic cells derived from a papillary urothelial grade 2 carcinoma developing within the prostate gland and urethra. The patient had undergone fulguration of a papillary neoplasm of the bladder 16 years ago. Epithelial neoplasms of the prostate have included forms that originate centrally in the vicinity of the urethra, and present a distinctive clinical and cystoscopic pattern with peculiar histological features. These rare neoplasms are considered to arise from the primary prostatic ducts 2 and often project into the prostatic urethra. They display different histological patterns, which sometimes are mixed in the same tumor. Adenocarcinomas, often with a papillary structure 3 - 6 and features similar to those of endometrial carcinomas, 7- 13 have been reported. Also, urothelial carcinomas 14- 20 and potentially invasive urothelial flat lesions have been identified. 21 The cytological pattern of these neoplasms rarely has been illustrated. Epstein reported on the aspiration cytology in a case of primary papillary carcinoma of the prostate. 22 Histologically, the neoplasm showed a mixed papillary and acinar pattern.
URETHROPROSTATIC PAPILLARY UROTHELIAL CARCINOMA
Likewise, in our case the neoplasm originated from the urothelium of the periurethral ducts, as suggested by the histological structure and growth pattern. REFERENCES
FIG. 2. A, papillary neoplasm partly occupying prostate. H & E, reduced from X50. B, neoplastic papillae growing within prostatic ducts. H & E, reduced from X315. C, in some areas neoplasm is invasive with differentiation towards squamous cell type. H & E, reduced from X500.
Although involvement of the prostate by a urothelial neoplasm is rare, this possibility must be considered in all patients with prior urothelial neoplasms. The prognosis of these tumors is different from that of common prostatic adenocarcinomas.
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