Skill and talent
Vesiculectomy with laparoscopic partial prostatectomy in the treatment of primary adenocarcinoma of the seminal vesicle with carcinomatous transformation of the ejaculatory duct
Vesiculectomía con prostatectomía parcial laparoscópica en el tratamiento del adenocarcinoma primario de vesícula seminal con transformación carcinomatosa del conducto eyaculador
J.C. Anguloa,
, I. Romeroa, P. Cabreraa, J. Gonzáleza, J.M. Rodríguez-Barberob, C. Núñez-Moraa
Corresponding author
a Servicio de Urología, Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain
b Servicio de Anatomía Patológica, Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain
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Relación topográfica entre vejiga y próstata con quiste de vesícula seminal y conducto eyaculador. B. Espécimen macroscópico de quiste seminal con neoformación vegetante y tejido que corresponde a la porción central prostática (a la derecha).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.C. Angulo, I. Romero, P. Cabrera, J. González, J.M. Rodríguez-Barbero, C. Núñez-Mora" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.C." "apellidos" => "Angulo" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Romero" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Cabrera" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "González" ] 4 => array:2 [ "nombre" => "J.M." "apellidos" => "Rodríguez-Barbero" ] 5 => array:2 [ "nombre" => "C." 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Angulo, I. Romero, P. Cabrera, J. González, J.M. Rodríguez-Barbero, C. Núñez-Mora" "autores" => array:6 [ 0 => array:4 [ "nombre" => "J.C." "apellidos" => "Angulo" "email" => array:2 [ 0 => "jangulo@futurnet.es" 1 => "jangulo.hugf@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Romero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "P." "apellidos" => "Cabrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J.M." "apellidos" => "Rodríguez-Barbero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "C." "apellidos" => "Núñez-Mora" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Urología, Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vesiculectomía con prostatectomía parcial laparoscópica en el tratamiento del adenocarcinoma primario de vesícula seminal con transformación carcinomatosa del conducto eyaculador" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2573 "Ancho" => 3361 "Tamanyo" => 1144778 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Description of the vesiculectomy and partial prostatectomy technique. A. Retrovesical cyst dissection after opening the peritoneum and Denonvillers. B. Ligation and section of the lateral pedicles of the cyst. C. Opening of the prostate up to the urethra, including verumontanum and central prostate in the resection specimen. D. Closure of the prostatic urethra and surgical site after removal of the specimen.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Primary tumors of the seminal vesicle (adenocarcinoma, sarcoma and lymphoma) are very rare lesions, which are often initiated by nonspecific symptoms.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Primary adenocarcinoma of the seminal vesicle usually occurs in patients aged more than 50 years. Detection by means of transrectal ultrasound, contrast CT or MRI of solid papillary mass in the seminal vesicle wall associated with palpable pelvic mass and elevation of serum CA-125 suggests the presence of these lesions, of which, at most, only several dozen cases have been reported with good clinical and histopathological correlation.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The histopathological pattern that is characteristic of seminal vesicle adenocarcinoma comprises fine structures of complex anastomosing papillary branching, which consists mainly of clear cuboidal cells or partially granular cells with some “hobnail” cells of round nuclei and occasional mitotic figures.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the light, these cells often produce Alcian blue epithelial mucin and positive mucicarmine. Immunohistochemical staining with CA-125 is typically positive while CEA, AFP, PSA and PAP are negative. This pattern helps to exclude other undifferentiated lesions of prostate or rectal origin with secondary infiltration of the seminal vesicle.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The treatment of these lesions is determined by the level of extension to nearby organs and by the patient's age. Already in 1967, Smith et al. recommended the radical inclusion of the prostate in the specimen, because the ejaculatory duct is often affected.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It therefore seems reasonable to propose radical prostatovesiculectomy in these patients when the tumor appears localized, especially when prostate invasion is suspected. However, some cases were treated with isolated vesiculectomy<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> with good clinical evolution. At times it was also necessary to consider cystectomy.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Radiation therapy seems to have been indicated as palliative treatment in very advanced cases with very bad prognosis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Other authors prescribed adjuvant therapy with antiandrogens or even orchiectomy,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> although there is no scientific basis for this.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of a 29-year-old male who consulted for azoospermia and isolated microhematuria. An ultrasound revealed a seminal vesicle cyst with a 5<span class="elsevierStyleHsp" style=""></span>cm diameter, with an appearance of partially solid contents in its interior and absence of the right kidney. Palpation revealed a small prostate, with normal consistency and a palpable soft mass on it. The testes and vas deferens were normal. Cystoscopy confirmed the absence of the right ureteral meatus.</p><p id="par0025" class="elsevierStylePara elsevierViewall">An abdominal CT scan revealed a structure of approximately 15<span class="elsevierStyleHsp" style=""></span>mm in diameter, in right para-aortic position, which could be related to dysplastic kidney. In the lower pelvis, cranially with respect to the prostate, we observed a preferably cystic ovoid lesion with a diameter of approximately 6<span class="elsevierStyleHsp" style=""></span>cm, but with a 2<span class="elsevierStyleHsp" style=""></span>cm solid area next to the wall. Given the renal dysplasia and the associated ureteral agenesis, these findings are consistent with cystic lesion dependent on seminal vesicle associated with congenital renal anomaly.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The pelvic MRI revealed retrovesical cystic formation in theoretical location of the seminal vesicles, measuring 5.9<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>7.4<span class="elsevierStyleHsp" style=""></span>cm. By means of a diffusion map (ADC), the study corroborated the existence of a solid papillary lesion, with behavior suggestive of malignancy in the anterolateral wall of the cyst, measuring 1.8<span class="elsevierStyleHsp" style=""></span>cm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). With the clinical impression that this was a malignant papillary lesion that had developed on the wall of a seminal vesicle cyst associated with renal agenesis and right renal dysplasia, we performed a transrectal ultrasound guided biopsy, which revealed atypical glandular proliferation, although it was not possible to properly evaluate the infiltrative nature of the lesion in the sample submitted. The neoformation comprised tubules of various sizes and forms, covered with very flattened cells with large nuclei and dense and irregular chromatin that protruded into the tubular lumen and stained CK7 intensely and CA-125 focally; CK20, PSA and PAP were negative. The most cellular portion of the sample expressed a proliferative Ki-67 index and overexpressed p53 in more than 25% of the cells. Given these findings, we ruled out prostate or urothelial origin and suspected seminal vesicle origin or that of other Müllerian remnants. Urine cytology was negative, and serum PSA was 0.46<span class="elsevierStyleHsp" style=""></span>ng/ml.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">With the suspicion that it was an adenocarcinoma on the wall of the seminal vesicle cyst, subjected to degeneration on malformative embryonic area, we considered the possibility of performing laparoscopic vesiculectomy, and also decided to perform pelvic lymphadenectomy and excision of the central portion of the gland to completely resect the margin of the ejaculatory ducts (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Surgical technique</span><p id="par0040" class="elsevierStylePara elsevierViewall">By means of a laparoscopic transperitoneal approach using 4 trocars, we opened the Douglas pouch; we identified, dissected, ligated and sectioned both vas deferens; we dissected the cyst and the seminal vesicles up to the prostatic base, subsequently advancing the dissection of the ejaculatory duct up to the prostatic urethra where we sectioned it. The specimen included the central portion of the prostate for histopathological analysis. We proceeded to extract the specimen in a laparoscopic bag and then closed the ventral surface of the prostatic urethra with 3-0 Monocryl continuous suture; we performed hemostasis of the surgical site, removed the trocars and closed by plane (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Histopathological diagnosis</span><p id="par0045" class="elsevierStylePara elsevierViewall">The resected cystic lesion showed an irregular outer surface, covered by adipose tissue and both vas deferens severed at the surface. The specimen was accompanied by a nodular area of 2.5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.5<span class="elsevierStyleHsp" style=""></span>cm in diameter, consisting of tissue with an elastic consistency that tallied with the central prostate area (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">During the histopathological study, we opened the cyst and found a hematic deposit associated with irregular papillary growth of clear cells with large, hyperchromatic nuclei and prominent nucleoli, as well as moderate mitotic activity. In several areas the pattern was cribriform and/or tubular, becoming solid (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). One tumoral area was calcified, suggesting its slow growth. In several areas, tubular structures of the neoplasia infiltrated the cyst wall, which comprised fibrous and muscular tissue; however, its surface was invasion-free and the remitted prostatic parenchyma that comprised the nodular area accompanying the cyst was also invasion-free. We found perineural and intraneural tumor invasion in the cyst wall. Likewise, the ejaculatory ducts had noninvasive malignant epithelial lining and the appearance of “intraductal” or <span class="elsevierStyleItalic">in situ</span> growth.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">From a purely histological viewpoint, the neoplasia was conspicuous due to the predominance of cells with clear cytoplasm (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), evidencing glycogen inside the cell in the PAS staining. The tumor was positive for cytokeratin AE1-AE3, cytokeratin 8-18 and cytokeratin 7. It was also intensely positive for epithelial membrane antigen (EMA) and racemase, and focally positive for CA-125. The proliferative index estimated with Ki-67 was moderate, around 15–20% in the most active foci. On the other hand, CK20, CK 8-18, CK 7, calretinin and PSA were negative.</p><p id="par0060" class="elsevierStylePara elsevierViewall">It was therefore an invasive clear cell papillary adenocarcinoma that had grown on the wall of a seminal vesicle cyst. The margins were negative, but the ejaculatory duct inside the partial prostatectomy specimen, which corresponded to the central part of the prostate, presented diffuse adenocarcinoma <span class="elsevierStyleItalic">in situ</span>, which almost reached the verumontanum, but did not manifest in the urethral lumen. The cystic structure drained into a single ejaculatory duct, which in turn emptied at the height of the verumontanum. We included the entire central portion of the prostate in the specimen (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Retrospectively, in the MRI, we observed the presence of a large caliber ejaculatory duct, draining into the urethra and the actual urethra anterior, connected to the bladder and displaced by the mass (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Despite our definitive findings of intraductal extension and perineural invasion in the specimen, the patient received no adjuvant treatment, as the surgical margins were negative. Postoperative recovery was excellent, showing continence and conserved erectile function. Thirteen months after an exhaustive follow-up, the patient is disease-free and has not presented any sequela arising from the surgery, although he requires IPDE to maintain erectile function. During the clinical follow-up, we performed uroflowmetry, cystoscopy, urine cytology and MRI without pathologic findings.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The persistence of Müllerian structures occurs when the paramesonephric ducts do not appropriately return in the male embryo, generating cysts in the prostatic utricle and/or Müllerian ducts.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> These remnants are often diagnosed as retrovesical mass in men in the second or third decade of life, when they produce hemospermia and ejaculatory duct obstruction. Some cases have been described of carcinomatous degeneration in the thickness of such cysts, such that both the seminal vesicles and the vas deferens empty into this cystic mass. These are usually adenocarcinomas of tubulopapillary clear cells, which bring to mind adenocarcinoma in the uterus or ovary.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–13</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Clear cell adenocarcinoma has also been described in the prostate utricle of adolescents and young men, which appears as a solid mass and/or cyst in the prostate midline under the bladder neck and is connected to the posterior urethra by means of a narrow canalicular segment.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> This type of tumors has a common cellularity described as “hobnail”. It is not entirely clear whether they originate from Wolffian remnants, Müllerian remnants or paraurethral glands. The manner in which this type of rare lesions with poor prognosis is often diagnosed is because they produce hematuria and obstructive symptoms of urinary flow or even urinary retention.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Their usual immunohistochemical profile is racemase, positive CK7 and CK20 variable CA-125 and negative p63.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> From a histogenetic point of view, clear cell adenocarcinoma of the urinary tract is urothelial in origin, although there is some similarity with some Müllerian tumors, including female and very rarely male.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Conceptually, the neoplasia we treated in this young man at the end of the third decade of his life was a primary clear cell adenocarcinoma of the seminal vesicle with tubulopapillary growth. There are similar cases that are also based on congenital cysts of the seminal vesicle and are also associated with renal agenesis<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> or with ureteral ectopia.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> It is most likely some kind of genetic disorder of unknown etiology that affects the genesis of this rare tumor. The dysgenetic condition manifested in the formation of the seminal cyst, of the coinciding dysplasia or agenesis, and its development at such an early age, supports the existence of a genetic-molecular explanation that is unknown today.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Despite the high proliferative rate of the tumor, its limited malignancy is determined by the fact that this degeneration occurs within the cyst, where it becomes focally invasive, although most of this lesion has a noninvasive parietal component that resembles intraductal carcinoma of the breast or ovary carcinoma <span class="elsevierStyleItalic">in situ</span>. The involvement of the whole epithelium of the ejaculatory duct in the thickness of the central area of the prostate confirms this diffuse or multifocal nature of the disease, but diagnosed at an early stage, if it is compared with the few cases of seminal vesicle adenocarcinoma classically described.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">This case exemplifies how it is possible to carry out a radical laparoscopic approach in this type of lesion, which must necessarily include pelvic lymphadenectomy and resection of the portion of prostate specimen housing the ejaculatory duct; in short, a total segmental partial prostatectomy. This ingenious situation, vesiculectomy with laparoscopic partial prostatectomy is a new technique described here for the first time, and which should be considered as the first choice in all the rare cases of seminal vesicle adenocarcinoma diagnosed early. The incidental appearance of this patient, who was studied for azoospermia, and the application of new methods of diagnostic imaging such as diffusion MRI allowed early diagnosis of the lesion and the approach of successful minimally invasive surgery of the tumor, including resection of the carcinomatous transformation of the ejaculatory duct.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres98349" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec85510" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres98350" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec85509" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical technique" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Histopathological diagnosis" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 11 => array:2 [ "identificador" => "xack35335" "titulo" => "Acknowledgement" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-01-26" "fechaAceptado" => "2011-01-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec85510" "palabras" => array:8 [ 0 => "Seminal vesicle" 1 => "Clear cell adenocarcinoma" 2 => "Surgical treatment" 3 => "Partial prostatectomy" 4 => "Central area" 5 => "Seminal vesicle cyst" 6 => "CA-125" 7 => "Azoospermia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec85509" "palabras" => array:8 [ 0 => "Vesícula seminal" 1 => "Adenocarcinoma de células claras" 2 => "Tratamiento quirúrgico" 3 => "Prostatectomía parcial" 4 => "Zona central" 5 => "Quiste de vesícula seminal" 6 => "CA-125" 7 => "Azoospermia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Primary adenocarcinoma of the seminal vesicle is an extremely rare condition. Some cases have been described in relation to congenital seminal vesicle cysts, which is often also associated with agenesia or ipsilateral renal disgenesia. The rareness of this type of lesions makes it difficult to plan a regulated surgical approach for them, although they are often treated by simple exeresis or exenteration, depending on their stage at the beginning.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present a new surgical technique that consists of radical vesiculectomy associated with laparoscopic partial prostatectomy (total segmentary) of the central area to successfully treat primary seminal vesicle adenocarcinoma in a young man who was diagnosed through an azoospermia study.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A study of the scan (MRI) with diffusion and the transrectal biopsy of the mass allowed us to make a thorough preoperative evaluation of the case, confirming the malignity and precociousness of the lesion. The laparoscopic approach allowed us to perform a pelvic lymphadenectomy and transperitoneal exeresis, including the central prostate area and suture of the posterior face of the urethra at the height of the apex of the prostate. The wall of the seminal cyst lesion confirmed infiltrating clear cell adenocarcinoma and non-invasive adenocarcinoma in the prostate segment of the central gland in the light of the ejaculatory conduct with “in situ” growth. Thus, the surgical specimen allowed radical exeresis with negative margins, guaranteeing minimally invasive surgery with preservation of continence and erection.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We describe a new integral approach for the radical surgery of localized primary adenocarcinoma of the seminal vesicle. Despite its exceptional nature, the case allowed for a double reflection: (a) the study of diffusion with MRI may suggest the diagnosis of malignity in this type of lesions; and (b) radical surgical treatment must include exeresis of the central portion of the prostate gland.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El adenocarcinoma primario de la vesícula seminal es una condición extremadamente rara. Se han descrito algunos casos en relación con quistes congénitos de la vesícula seminal, que a menudo se asocian también con agenesia o disgenesia renal ipsilateral. La rareza de este tipo de lesiones dificulta la planificación de un planteamiento quirúrgico reglado de las mismas, aunque habitualmente se tratan mediante exéresis simple o exenteración, según el estadio de las mismas al comienzo.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Presentamos una nueva técnica quirúrgica, consistente en vesiculectomía radical asociada a prostatectomía parcial laparoscópica (segmentaria total) de la zona central para tratar con éxito un adenocarcinoma primario de vesícula seminal en un varón joven, al que se le detectó por un estudio de azoospermia.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El estudio de imagen mediante resonancia magnética (RM) con difusión y la biopsia transrectal de la masa permitió una evaluación preoperatoria minuciosa del caso, confirmando malignidad y la precocidad de la lesión. El abordaje laparoscópico permitió llevar a cabo linfadenectomía pélvica y exéresis transperitoneal, incluyendo la zona central prostática y suturando la cara posterior de la uretra a la altura del ápex prostático. La lesión quística seminal confirmó en su pared un adenocarcinoma de células claras infiltrante, y el segmento prostático de la glándula central un adenocarcinoma no invasivo en la luz del conducto eyaculador con crecimiento <span class="elsevierStyleItalic">in situ</span>. Así, el espécimen quirúrgico permitió la exéresis radical con márgenes negativos, garantizando el carácter de cirugía mínimamente invasiva, con preservación de la continencia y de la erección.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se describe un nuevo abordaje integral para el planteamiento quirúrgico radical del adenocarcinoma primario de vesícula seminal localizado. A pesar de su carácter excepcional, el caso permite llevar a cabo una doble reflexión: a) el estudio de difusión con RM puede sugerir el diagnóstico de malignidad en este tipo de lesiones; y b) el tratamiento quirúrgico radical debe incluir la exéresis de la porción central de la glándula prostática.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Angulo JC, et al. Vesiculectomía con prostatectomía parcial laparoscópica en el tratamiento del adenocarcinoma primario de vesícula seminal con transformación carcinomatosa del conducto eyaculador. Actas Urol Esp. 2011;35:304–09.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1121 "Ancho" => 3418 "Tamanyo" => 282395 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Retrovesical cyst with parietal exophytic growth in MRI. A. Transverse T2 showing intracyst protein content. B. ADC map parietal lesion suggestive of malignancy. C. Sagittal T2-weighted MRI showing relationship between the mass, the ejaculatory duct and the central prostate, as well as the rejected urethra and bladder.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2573 "Ancho" => 3361 "Tamanyo" => 1144778 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Description of the vesiculectomy and partial prostatectomy technique. A. Retrovesical cyst dissection after opening the peritoneum and Denonvillers. B. Ligation and section of the lateral pedicles of the cyst. C. Opening of the prostate up to the urethra, including verumontanum and central prostate in the resection specimen. D. Closure of the prostatic urethra and surgical site after removal of the specimen.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1235 "Ancho" => 3415 "Tamanyo" => 795001 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A. Topographical relationship between bladder and prostate with seminal vesicle cyst and ejaculatory duct. B. Macroscopic specimen of seminal cyst with vegetative neoformation and tissue corresponding to the central part of the prostate (on the right).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1491 "Ancho" => 3418 "Tamanyo" => 1629564 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Neoplastic lesion consisting of: A. adenocarcinoma with mixed tubular growth pattern, B. papillary and C. solid with predominance of clear cells (hematoxylin–eosin, 100×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary mucinous adenocarcinoma of a seminal vesicle cyst associated with ectopic ureter and ipsilateral renal agenesis: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2018 March | 5 | 0 | 5 |
| 2018 February | 22 | 2 | 24 |
| 2018 January | 34 | 1 | 35 |
| 2017 December | 27 | 2 | 29 |
| 2017 November | 36 | 1 | 37 |
| 2017 October | 34 | 2 | 36 |
| 2017 September | 39 | 11 | 50 |
| 2017 August | 20 | 1 | 21 |
| 2017 July | 32 | 4 | 36 |
| 2017 June | 45 | 14 | 59 |
| 2017 May | 36 | 10 | 46 |
| 2017 April | 32 | 4 | 36 |
| 2017 March | 46 | 25 | 71 |
| 2017 February | 116 | 4 | 120 |
| 2017 January | 46 | 1 | 47 |
| 2016 December | 57 | 5 | 62 |
| 2016 November | 81 | 10 | 91 |
| 2016 October | 84 | 7 | 91 |
| 2016 September | 60 | 5 | 65 |
| 2016 August | 47 | 3 | 50 |
| 2016 July | 45 | 2 | 47 |
| 2016 June | 47 | 16 | 63 |
| 2016 May | 49 | 7 | 56 |
| 2016 April | 39 | 26 | 65 |
| 2016 March | 43 | 6 | 49 |
| 2016 February | 53 | 18 | 71 |
| 2016 January | 40 | 11 | 51 |
| 2015 December | 39 | 11 | 50 |
| 2015 November | 29 | 10 | 39 |
| 2015 October | 48 | 13 | 61 |
| 2015 September | 19 | 7 | 26 |
| 2015 August | 66 | 6 | 72 |
| 2015 July | 79 | 6 | 85 |
| 2015 June | 52 | 2 | 54 |
| 2015 May | 41 | 1 | 42 |
| 2015 April | 57 | 12 | 69 |
| 2015 March | 44 | 6 | 50 |
| 2015 February | 31 | 3 | 34 |
| 2015 January | 46 | 6 | 52 |
| 2014 December | 36 | 7 | 43 |
| 2014 November | 35 | 3 | 38 |
| 2014 October | 51 | 10 | 61 |
| 2014 September | 50 | 8 | 58 |
| 2014 August | 52 | 5 | 57 |
| 2014 July | 46 | 5 | 51 |
| 2014 June | 31 | 4 | 35 |
| 2014 May | 20 | 3 | 23 |
| 2014 April | 19 | 1 | 20 |
| 2014 March | 34 | 5 | 39 |
| 2014 February | 28 | 6 | 34 |
| 2014 January | 32 | 2 | 34 |
| 2013 December | 33 | 2 | 35 |
| 2013 November | 37 | 4 | 41 |
| 2013 October | 56 | 5 | 61 |
| 2013 September | 43 | 4 | 47 |
| 2013 August | 30 | 6 | 36 |
| 2013 July | 8 | 1 | 9 |
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