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Large cystic ductal carcinoma of the prostate: imaging findings and minimally invasive surgical treatment
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  1. Fabio Cesar Miranda Torricelli1,
  2. Marcos Tucherman2,
  3. Rodrigo Melogno3,
  4. Rafael Ferreira Coelho1,2
  1. 1University of São Paulo Medical School, São Paulo, Brazil
  2. 2Hospital Israelita Albert Einstein, São Paulo, Brazil
  3. 3Hospital Britanico, Montevideo, Uruguay
  1. Correspondence to Dr Rafael Ferreira Coelho, coelhouro{at}yahoo.com.br

https://doi.org/10.1136/bcr-2014-207072

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    Description

    Prostatic ductal carcinoma (PDC) is a rare histological subtype of prostate cancer usually diagnosed in a more advanced stage, presenting with a higher mortality rate than acinar prostate carcinoma.1–3

    A 65-year-old asymptomatic man presented with a pelvic cystic lesion diagnosed during a routine ultrasound. The prostate specific antigen (PSA) level was 3.5 ng/mL and digital rectal examination revealed a large cystic mass in the prostate topography. MRI showed a large multiloculated contrast-enhanced cystic lesion with thick septations arising from the retroprostatic and left pararectal space (6.5×5.0×5.0 cm; figure 1). Prostate biopsy revealed a prostatic acinar carcinoma in 1 of 14 cores (Gleason 7) located in the right mid, associated with a PDC in 3 of 14 cores located in the left lateral base of the prostate. Immunohistochemistry analysis was positive for PSA and α-methylacyl coenzyme A racemase (AMACR). CT scan and bone scan were negative for metastasis. Based on these findings, the patient underwent a robotic-assisted laparoscopic prostatectomy with pelvic lymphadenectomy (figure 2). There were no intraoperative or postoperative complications. Pathological examination showed a prostatic acinar carcinoma Gleason 7 (4+3) associated with a PDC in 30% of the gland with no positive lymph nodes (0/20). Extensive extracapsular extension was present in the left base; the surgical margins were negative (pT3aN0; figure 3). After 12 months of follow-up the patient has no evidence of disease and serum PSA level is undetectable.

    Figure 1
    Figure 1

    MRI showing a large multiloculated contrast-enhanced cystic lesion. (A) Axial view, (B) sagittal view and (C) coronal view.

    Figure 2
    Figure 2

    Intraoperative view.

    Figure 3
    Figure 3

    Pathological examination revealing large glands lined by tall, pseudostratified epithelium.

    To the best of our knowledge, this is the first robotic-assisted prostatectomy for management of large PDC, showing that it is a treatment option for this uncommon condition.

    Learning points

    • Prostatic ductal carcinoma (PDC) is a rare histological subtype of prostate cancer.

    • MRI is a useful tool for PDC diagnosis.

    • Minimally invasive surgery is an option for treatment of this uncommon condition.

    Acknowledgments

    The authors acknowledged Renee Zon Filippi, MD—pathologist who reviewed the surgical specimen; and Giuliano Betoni Guglielmetti, MD—urologist who was involved with the patient's care.

    References

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      . Incidence and outcomes of ductal carcinoma of the prostate in the USA: analysis of data from the Surveillance, Epidemiology, and End Results program. BJU Int 2012;109:831–4.
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      3. Pan J, et al
      . Ductal adenocarcinoma of the prostate: immunohistochemical findings and clinical significance. Onco Targets Ther 2013;6:1501–6.
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      1. Epstein JI
      . Prostatic ductal adenocarcinoma: a mini review. Med Princ Pract 2010;19:82–5.
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    View Abstract

    Footnotes

    • Contributors FCMT drafted the article. MT contributed in the data acquisition. RM contributed in the data acquisition, conception and design. RFC performed critical revision for intellectual content.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.