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      A 5-year follow-up of primary seminal vesicle adenocarcinoma : A case report

      case-report
      , MD, , MD
      Medicine
      Wolters Kluwer Health
      case report, diagnosis, long-term survival, primary seminal vesicle adenocarcinoma, treatment

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          Abstract

          Rationale:

          Primary seminal vesicle adenocarcinoma (PSVA) is an extremely rare malignancy that should be carefully differentiated from cancer originating in the prostate, colon or bladder. Without standard guidelines, radical resection is considered a mainstay treatment, providing the best prognosis. However, as manifestations of PSVA are not detected in early stages, the majority of cases of PSVA are diagnosed at late stages, contributing to poor prognosis.

          Patient concerns:

          We described the case of a PSVA patient confirmed by histopathology and immunohistochemistry (IHC) staining positive for carbohydrate antigen-125 (CA-125) and negative for prostate specific antigen (PSA).

          Diagnosis:

          Primary seminal vesicle adenocarcinoma.

          Interventions:

          Surgery was carried out at the beginning, however, residual tumor was verified; thus 3 cycles of chemotherapy with a regimen of paclitaxel and cis-platinum were performed, followed by radical pelvic radiotherapy with a dose of 60 Gray in 30 fractions; then, another 3 cycles of the same chemotherapy were carried out.

          Outcomes:

          At the moment, the patient is still under follow-up and has been disease-free for more than 5 years.

          Lessons:

          Our manuscript describes a patient with PSVA with long-term survival and supplies a successful management strategy for this malignancy.

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          Most cited references20

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          Primary adenocarcinoma of the seminal vesicles.

          We provide an overview of seminal vesicle carcinoma, a rare entity that is difficult to diagnose and traditionally has been associated with a poor prognosis. A literature search for seminal vesicle carcinoma was performed, and current concepts related to the diagnosis and clinical management were reviewed. Two unpublished additional cases recently treated at our institution were added to the international experience. Special attention was given to new developments in diagnostic methods. Histopathological changes and biomarker criteria are provided to allow accurate diagnosis of this condition. Early diagnosis of seminal vesicle carcinoma has often been difficult due to a lack of immunohistochemical markers that distinguish this entity from invasive adenocarcinoma of adjacent organs. A total of 49 documented cases of seminal vesicle carcinoma in men between 19 and 90 years old has been reported in the current literature. Two additional cases that were diagnosed and treated at our institution are incorporated into this review. Recently the tissue marker CA 125 has substantially increased the accurate diagnosis of seminal vesicle carcinoma. In addition, increased serum CA 125 in patients with this disease has been reported and serum levels correlate well with the clinical course of the disease. Radical surgery in combination with adjuvant radiotherapy or androgen deprivation has resulted in long-term palliation in some patients with advanced disease. Including seminal vesicle carcinoma in the differential diagnosis of lower urinary tract symptoms will improve detection. Improved imaging tools and the availability of a serum marker will undoubtedly enhance detection at the earliest stages. More defined histopathological criteria will allow diagnosis even with small biopsy specimens. Radical surgery appears to offer the best chance for cure but hormonal manipulation and radiotherapy seem to be effective as adjuvant treatment modalities.
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            Primary seminal vesicle carcinoma: an immunohistochemical analysis of four cases.

            Primary adenocarcinoma of the seminal vesicles is an extremely rare neoplasm. Because prompt diagnosis and treatment are associated with improved long-term survival, accurate recognition of this neoplasm is important, particularly when evaluating limited biopsy material. Immunohistochemistry can be used to rule out neoplasms that commonly invade the seminal vesicles, such as prostatic adenocarcinoma. Previous reports have shown that seminal vesicle adenocarcinoma (SVCA) is negative for prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PAP); however, little else is known of its immunophenotype. Consequently, we evaluated the utility of cancer antigen 125 (CA-125) and cytokeratin (CK) subsets 7 and 20 for distinguishing SVCA from other neoplasms that enter the differential diagnosis. Four cases of SVCA-three cases of bladder adenocarcinoma and a rare case of adenocarcinoma arising in a mullerian duct cyst-were immunostained for CA-125, CK7, and CK20. Three of four cases of SVCA were CA-125 positive and CK7 positive. All four cases were CK20 negative. All bladder adenocarcinomas and the mullerian duct cyst adenocarcinoma were CK7 positive and negative for CA-125 and CK20. In addition, CA-125 immunostaining was performed in neoplasms that commonly invade the seminal vesicles, including prostatic adenocarcinoma (n = 40), bladder transitional cell carcinoma (n = 32), and rectal adenocarcinoma (n = 10), and all were negative for this antigen. In conclusion, the present study has shown that the CK7-positive, CK20-negative, CA-125-positive, PSA/PAP-negative immunophenotype of papillary SVCA is unique and can be used in conjunction with histomorphology to distinguish it from other tumors that enter the differential diagnosis, including prostatic adenocarcinoma (CA-125 negative, PSA/PAP positive), bladder transitional cell carcinoma (CK20 positive, CA-125 negative), rectal adenocarcinoma (CA-125 negative, CK7 negative, CK20 positive), bladder adenocarcinoma (CA-125 negative), and adenocarcinoma arising in a mullerian duct cyst (CA-125 negative).
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              Carcinoma of the seminal vesicle.

              Strict criteria were applied to 12 cases of carcinoma of the seminal vesicle in the Mayo Clinic tumor registry. Diagnosis was carcinoma of the seminal vesicle if the neoplasm was a papillary or anaplastic carcinoma localized primarily to the seminal vesicle and no other primary tumors were demonstrated. In addition, some degree of mucin production was required, especially when prostatic involvement was present. Only 2 of our cases and 35 cases reported previously were judged acceptable or probable cases of carcinoma of the seminal vesicle. Prognosis for patients with this tumor is poor. A combination of extirpative surgery and hormonal therapy appears to provide the best opportunity for extended survival, although this remains to be proved.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                October 2018
                12 October 2018
                : 97
                : 41
                : e12600
                Affiliations
                Huazhong University of Science and Technology, Tongji Medical College, Tongji Hospital, Department of Geriatrics, Wuhan, China.
                Author notes
                []Correspondence: Yueqiang Jiang, Tongji Hospital of Tongji Medical College of Huazhong University of Science and, Technology, Wuhan, Hubei, China (e-mail: jyqwh@ 123456163.com ).
                Article
                MD-D-18-03006 12600
                10.1097/MD.0000000000012600
                6203478
                30313047
                6847924f-2b5f-4802-8bcc-b6e1aeb10248
                Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                : 8 May 2018
                : 3 September 2018
                Categories
                7300
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                case report,diagnosis,long-term survival,primary seminal vesicle adenocarcinoma,treatment

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