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Unusual Retrovesical Cystic Mass in a Male Patient
Images in Clinical Urology Unusual Retrovesical Cystic Mass in a Male Patient Arundeep Arora, Sanjay Sharma, and Amlesh Seth Primary tumors of the seminal vesicles are very rare, with most reported cases being malignant. Benign tumors of the seminal vesicles are even rarer. A spectrum of tumors is derived from both epithelium and stroma and constitutes a distinct subset termed “epithelial-stromal tumors.” We present the classic imaging findings of a cystadenoma of the seminal vesicles in a 23-year-old man, who presented with lower abdominal pain and obstructive urinary symptoms. UROLOGY 81: e23ee24, 2013. Crown Copyright 2013 Published by Elsevier Inc.
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23-year-old man presented with lower abdominal pain and obstructive urinary symptoms. Digital rectal examination revealed a normal prostate but a soft, painless mass anterior to the rectum. Ultrasonography (Fig. 1) and magnetic resonance imaging (Figs. 2 and 3) showed the presence of a multiseptated cystic lesion with a heterogeneous signal intensity that was located cranial to the prostate and probably originated from the seminal vesicles. Surgical excision and histopathologic examination confirmed the features of cystadenoma of the seminal vesicles. True benign primary tumors are even rarer than malignant neoplasms and include cystadenomas. Soule and Dockerty1 first reported cystadenoma of the seminal vesicle as a “pathologic curiosity” in 1951. The clinical features include being asymptomatic, abdominal pain, hematuria, hemospermia, and lower urinary tract symptoms.2 Immunohistochemical analysis using prostate-specific antigen and prostatic acid phosphatase can be done to exclude a prostatic origin.3 They are usually identified on ultrasound or computed tomography scans; however, coronal and sagittal multiplanar scanning with magnetic resonance imaging is the best method to identify its origin from the seminal vesicle.4 Surgical excision is advised, even in asymptomatic tumors,5 because of the paucity of data to support a conservative approach to a seminal vesicle tumor. The prognosis is invariably good, without recurrence.6 Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India; and Department of Urology, All India Institute of Medical Sciences, New Delhi, India Reprint requests: Sanjay Sharma, M.D., Department of Radiodiagnosis, All India Institute of Medical Sciences, Room No. 69, New Delhi 29, India. E-mail: drssharma@ hotmail.com Submitted: June 11, 2012, accepted (with revisions): October 12, 2012
Crown Copyright ª 2013 Published by Elsevier Inc. All Rights Reserved
Figure 1. Transrectal sagittal ultrasound image showing multiseptated cystic mass located cranial to prostate.
References 1. Soule EH, Dockerty MB. Cystadenoma of the seminal vesicle, a pathologic curiosity: report of a case and review of the literature concerning benign tumors of the seminal vesicle. Mayo Clinic Proc. 1951;26:406-414. 2. Lee CB, Choi HJ, Cho DH, et al. Cystadenoma of the seminal vesicle. Int J Urol. 2006;13:1138-1140. 3. Santos LD, Wong CSKC, Killingsworth M. Cystadenoma of the seminal vesicle: report of a case with ultrastructural findings. Pathology. 2001;33:399-402. 4. Tock EP, Hoe J, Foo KT. Haemorrhagic papillary cystadenoma of the seminal vesicle mimicking giant seminal vesicle cyst: MRI appearances. Ann Acad Med Singapore. 1991;20:792-794. 5. Lorber G, Pizov G, Gofrit ON, et al. Seminal vesicle cystadenoma: a rare clinical perspective. Eur Urol. 2011;60:388-391. 6. Gil AO, Yamakami LY, Genzini T. Cystadenoma of the seminal vesicle. Int Braz J Urol. 2003;29:434-436.
0090-4295/12/$36.00 http://dx.doi.org/10.1016/j.urology.2012.10.022
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Figure 2. Axial (A) T1-weighted and (B) T2-weighted magnetic resonance imaging scans showing retrovesical mass, with internal contents hyperintense on T1-weighted (A) and T2-weighted (B) sequences and multiple internal septae. Asterisk indicates compressed urinary bladder anterior to mass.
Figure 3. (A) Sagittal T2-weighted sequence showing cystic mass (asterisk) posteroinferior to urinary bladder. Note, compressed prostate inferior to mass (white arrow). (B) Contrast-enhanced T1-weighted sequence showing thin enhancing septae (white arrow) within mass.
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UROLOGY 81 (3), 2013
A
23-year-old man presented with lower abdominal pain and obstructive urinary symptoms. Digital rectal examination revealed a normal prostate but a soft, painless mass anterior to the rectum. Ultrasonography (Fig. 1) and magnetic resonance imaging (Figs. 2 and 3) showed the presence of a multiseptated cystic lesion with a heterogeneous signal intensity that was located cranial to the prostate and probably originated from the seminal vesicles. Surgical excision and histopathologic examination confirmed the features of cystadenoma of the seminal vesicles. True benign primary tumors are even rarer than malignant neoplasms and include cystadenomas. Soule and Dockerty1 first reported cystadenoma of the seminal vesicle as a “pathologic curiosity” in 1951. The clinical features include being asymptomatic, abdominal pain, hematuria, hemospermia, and lower urinary tract symptoms.2 Immunohistochemical analysis using prostate-specific antigen and prostatic acid phosphatase can be done to exclude a prostatic origin.3 They are usually identified on ultrasound or computed tomography scans; however, coronal and sagittal multiplanar scanning with magnetic resonance imaging is the best method to identify its origin from the seminal vesicle.4 Surgical excision is advised, even in asymptomatic tumors,5 because of the paucity of data to support a conservative approach to a seminal vesicle tumor. The prognosis is invariably good, without recurrence.6 Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India; and Department of Urology, All India Institute of Medical Sciences, New Delhi, India Reprint requests: Sanjay Sharma, M.D., Department of Radiodiagnosis, All India Institute of Medical Sciences, Room No. 69, New Delhi 29, India. E-mail: drssharma@ hotmail.com Submitted: June 11, 2012, accepted (with revisions): October 12, 2012
Crown Copyright ª 2013 Published by Elsevier Inc. All Rights Reserved
Figure 1. Transrectal sagittal ultrasound image showing multiseptated cystic mass located cranial to prostate.
References 1. Soule EH, Dockerty MB. Cystadenoma of the seminal vesicle, a pathologic curiosity: report of a case and review of the literature concerning benign tumors of the seminal vesicle. Mayo Clinic Proc. 1951;26:406-414. 2. Lee CB, Choi HJ, Cho DH, et al. Cystadenoma of the seminal vesicle. Int J Urol. 2006;13:1138-1140. 3. Santos LD, Wong CSKC, Killingsworth M. Cystadenoma of the seminal vesicle: report of a case with ultrastructural findings. Pathology. 2001;33:399-402. 4. Tock EP, Hoe J, Foo KT. Haemorrhagic papillary cystadenoma of the seminal vesicle mimicking giant seminal vesicle cyst: MRI appearances. Ann Acad Med Singapore. 1991;20:792-794. 5. Lorber G, Pizov G, Gofrit ON, et al. Seminal vesicle cystadenoma: a rare clinical perspective. Eur Urol. 2011;60:388-391. 6. Gil AO, Yamakami LY, Genzini T. Cystadenoma of the seminal vesicle. Int Braz J Urol. 2003;29:434-436.
0090-4295/12/$36.00 http://dx.doi.org/10.1016/j.urology.2012.10.022
e23
Figure 2. Axial (A) T1-weighted and (B) T2-weighted magnetic resonance imaging scans showing retrovesical mass, with internal contents hyperintense on T1-weighted (A) and T2-weighted (B) sequences and multiple internal septae. Asterisk indicates compressed urinary bladder anterior to mass.
Figure 3. (A) Sagittal T2-weighted sequence showing cystic mass (asterisk) posteroinferior to urinary bladder. Note, compressed prostate inferior to mass (white arrow). (B) Contrast-enhanced T1-weighted sequence showing thin enhancing septae (white arrow) within mass.
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UROLOGY 81 (3), 2013