DIFFUSE LARGE B-CELL LYMPHOMA OF THE PROSTATE IN A YOUNG PATIENT
CARLOS A. ALVAREZ, BEGONA I. RODRIGUEZ, LUIS A. PEREZ
Department of Pathology (CAA, BIR) and Department of Urology (LAP), Hospital POVISA, Vigo, Spain
We report a primary lymphoma of the prostate, which arose in a 29-year-old man with hematuria. Pathological evaluation of tissue fragments allowed us to choose appropriate medical management. A diagnosis of suspicion can be performed by urine cytology, and molecular techniques may be helpful. Emphasis in differential diagnosis is made.
words: prostatic neoplasms; diagnosis; lymphoma, non-Hodgkin;
Primary lymphomas of the prostate are a rare but well-recognized entity. They account for 0.09% of prostate neoplasms and 0.1% of all non-Hodgkin lymphomas (1). The symptoms at presentation are similar to other prostatic diseases (2), and histopathological analysis with immunohistochemical techniques and molecular studies are mandatory to reach final diagnosis. Although rare, this entity should be kept in mind to avoid unnecessary surgery.
29-year-old male presented a 3-month history of mild hematuria. Urine
cytology revealed atypical cells of uncertain histogenesis. Several submucosal
nodules were seen on cystoscopy involving the prostatic urethra, and a
biopsy was performed. Microscopically, an ulcerated neoplasm made up of
large discohesive cells infiltrating prostatic tissue was observed. The
cells had abundant amphophilic cytoplasm, pleomorphic nuclei and prominent
nucleoli (Figure-1). Mitoses were frequent and often atypical. Malignant
cells expressed immunoreactivity for CD20 (Figure-2) and CD30 (focally),
and were negative for CD3, CD10, CD15, LMP-1, p53, bcl2 and bcl6. Polymerase
chain reaction analyses demonstrated monoclonal immunoglobulin heavy-chain
gene rearrangement. Bone marrow biopsy, complete blood count, serum prostate-specific
antigen (PSA) and computerized tomography of the thorax, abdomen, and
pelvis were normal. Gallium scan revealed a focus of isotope retention
in the prostate. A final diagnosis of primary diffuse large B-cell lymphoma
(DLBCL) of the prostate was rendered.
lymphoma may be either primary in the prostate, with an origin in rudimentary
lymphoid nodules or extramedullary hematopoiesis, or it is an spread from
the involvement in disseminated disease (1,2). Criteria to classify a
lymphoma as primary include urinary symptoms at presentation and prostate
confined tumor, without involvement of the hematopoietic system within
1 month of diagnosis (2).