2019-17 / JUNE 10

A 78 year old man presented with a mass in the left seminal vesicle. A cystoprostatectomy was performed.


1- What is the correct diagnosis?

a. Adenocarcinoma of the prostate invading the seminal vesicle

b. Adenocarcinoma of the bladder invading the seminal vesicle

c. Mixed epithelial stromal tumor of the seminal vesicle

d. Primary seminal vesicle adenocarcinoma

Primary seminal vesicle adenocarcinoma

In this case, the tumor is centered on the seminal vesicles with extension into the periseminal vesicle tissue; the rest of the cystoprostatectomy specimen showed no tumor in the bladder or prostate, and the colon was negative with imaging. Focally, there appears to be carcinoma within the seminal vesicle epithelium that could be consistent with an in-situ component, although one cannot exclude with certainty colonization by the invasive tumor. The tumor shows two distinct morphologies. Areas show a well-differentiated adenocarcinoma composed of individual glands and another area with a higher grade lesion showing papillary and cribriform architecture. In this case, the tumor was focally positive for CK7, CK903, and PAX8 with negative stains for CDX2, GATA3, PSA, PSAP (done on the outside), NKX3.1, and P501S. Primary adenocarcinoma in the seminal vesicle is rare with about 60 confirmed cases. Men present at a mean age of 63 years (range 17 to 90 years) with urinary bladder outlet obstruction with or without hematuria and hemospermia. Diagnostic criteria are: 1) Papillary or anaplastic carcinoma, localized mainly or exclusively to the seminal vesicle; 2) No other primary carcinoma elsewhere; 3) Prostatic, urinary bladder, and colorectal carcinomas ruled out; and 4) Negative prostate PSA, PSAP, NKX3.1, P501S) immunostains. Papillary, solid, cribriform, and tubulopapillary growth patterns may be seen. Mucinous features, with intraluminal and intracytoplasmic mucin may be prominent. Papillary growth of clear cells with hobnail nuclei, has also been observed. The tumor cell cytoplasm lacks the lipofuscin pigment of normal seminal vesicle epithelium. Immunostains for CA125, CK7, CEA are frequently positive, with variable staining for PAX8 and prostate markers are negative. Metastatic spread occurs to regional lymph nodes, lungs, and viscera. 95% of patients are dead of disease within three years.

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Jonathan Epstein
Johns Hopkins Hospital

Seminal vesicle

Seminal Vesicle adenocarcinoma