Year : 2006 | Volume
: 22 | Issue : 1 | Page : 66--67
Primary prostatic leiomyosarcoma in an adult
Naresh K Agarwal1, LN Dorairajan1, Santosh Kumar1, Chandra Murthy1, R Krishnan2,
1 Departments of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry - 605 006, India
2 Departments of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry - 605 006, India
L N Dorairajan
Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry - 605 006
Leiomyosarcoma of prostate is rare accounting for 0.1% of prostatic malignancies. It has a very poor prognosis although rate of survival is variable. Treatment recommendations are difficult to establish due to the rarity of the tumour. Here we report a case of primary prostatic leiomyosarcoma in an adult treated by primary excision of mass followed by doxorubicin based chemotherapy. Patient subsequently developed local recurrence and disseminated secondaries and was then lost to follow up.
|How to cite this article:|
Agarwal NK, Dorairajan L N, Kumar S, Murthy C, Krishnan R. Primary prostatic leiomyosarcoma in an adult.Indian J Urol 2006;22:66-67
|How to cite this URL:|
Agarwal NK, Dorairajan L N, Kumar S, Murthy C, Krishnan R. Primary prostatic leiomyosarcoma in an adult. Indian J Urol [serial online] 2006 [cited 2020 Nov 28 ];22:66-67
Available from: https://www.indianjurol.com/text.asp?2006/22/1/66/24661
Primary prostate sarcomas are rare tumours occurring from non epithelial mesenchymal components of prostatic stroma. These tumours account for 0.1% of prostatic malignancies. The three small series in past are from Sexton et al , Russo et al (10 cases) and Cheville et al . Cheville et al reported 23 cases in a review span of 65 years with clinical information in only 14 cases. N. Mondanini et al reported 3 cases from 1984 to 2002 recently. Leiomyosarcoma is the most common histological type in adults, whereas rhabdomyosarcoma is more common in paediatric patients. We report a case of prostatic leiomyosarcoma in a young male managed by excision of the mass followed by doxorubicin based chemotherapy.
A 47 year old man presented with a history of increased frequency and straining to micturate for 6 months. He was catheterized for acute urinary retention 15 days back. Abdominal examination revealed a smooth solid mass arising from the pelvis, extending up to the umbilicus. Per rectally a bimanually palpable nodular mass replacing the prostate was protruding into the rectum with mucosa adherent at some areas. Computerised tomography (CT) showed a 10 x10 cm heterogeneous mass arising from the prostate displacing bladder and rectum [Figure 1]. Prostatic biopsy showed low grade leiomyosarcoma sparing the rectal wall. Metastatic work up was negative. Patient was not willing to undergo cystoprostatectomy and urinary and possibly faecal diversion. At laparotomy the mass was large and found to be arising from the prostate, displacing the bladder and the rectum. The mass was excised and incidental openings in the rectum and prostatic urethra were repaired. Gross specimen contained a lobulated solid mass approximately 10 cm x 10 cm size with varied consistency. Histological examination showed a low grade leiomyosarcoma [Figure 2]. Postoperatively the patient received 3 cycles chemotherapy consisting of doxorubicin, cyclophosphamide and cisplatin. He was symptom free and showed no recurrence upto one year follow up, both clinically and on postoperative CT scans. However subsequently (at two years follow up) he developed local recurrence and disseminated peritoneal secondaries that were confirmed on follow up CT scans and was then lost to follow up.
Contemporary data on prostatic sarcoma is limited. The three small series in past are from Sexton et al (21 cases in the last 3 decades), Russo et al (10 cases) and Cheville et al . Cheville et al reported 23 cases in a review span of 65 years with clinical information in only 14 cases. N. Mondanini et al reported 3 cases from 1984 to 2002 recently. Surgery has been the mainstay in treatment and usually involves cystoprostatectomy. Radical prostatectomy or more conservative surgery may be an option if the sarcoma is small and confined to prostate. The rare occurrence of adult prostate sarcoma has limited the critical evaluation of treatment strategies and patient survival is restricted to anecdotal experience. The overall survival rate for adult patients with prostatic sarcoma is poor usually due to lack of early symptoms and late presentation and ranges from 0 to 60% in various series.
Those patients having negative surgical margins have higher survival than those who have positive surgical margin. However patients with high grade tumour, size more than 5 cm and AJCC stage III have no survival difference with those patients having low grade, size less than 5cm and AJCC stage I, II. Sexton et al suggest that there may be a survival advantage for patients treated with a combined multimodality approach, although surgery remains the mainstay of treatment and usually involves cystoprostatectomy. Preoperative radiotherapy had appreciable downsizing of primary tumour. In the Sexton series the overall survival rate for these patients was 38% compared to 0 to 60% in other series.
In our case as the patient did not agree for radical surgery we have done excision of the mass followed by 3 cycles of doxorubicin based chemotherapy. He was symptom free and showed no recurrence at 1 yr follow up. Subsequently he developed local recurrence with disseminated peritoneal secondaries and was then lost to follow up. Perhaps the outcome could have been better had the patient agreed to undergo radical surgery with urinary diversion. Nevertheless the surgery provided him useful palliation as he was voiding well without catheter even when the disease had extensively disseminated.
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