BJU International 2001 88 (4cr), 442

S. Siracusano, R. Bortolus*, S. Stener, V. Pecorari and R. Bussani†

Department of Urology and † Pathology, University of Trieste, and * Department of Radiotherapy, National Cancer Institute of Aviano, Italy

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A 71-year-old man had a decreased urinary stream for 2 years and obstipation for 2 months. A DRE showed a large prostate and an increase in parenchymal consistency on the left side. Urine analysis and urine culture results were negative, and the values for routine haematology and chemistry were normal; his serum total PSA was 5.7 ng/mL. The results of a bone scan and chest X-ray were normal. A sextant prostatic biopsy was negative for prostatic carcinoma while abdominal CT showed the presence of a 4 × 3 cm solid mass in the right seminal vesicle (Fig. 1). A biopsy of this solid mass diagnosed the presence of a small-cell carcinoma of the seminal vesicle; this was confirmed by histology and immunohistochemistry. Histologically, there was a thin connective tissue tract extensively infiltrated by poorly differentiated neoplastic cells. The neoplasm was composed of small round cells with scanty cytoplasm and large hyperchromatic and atypical nuclei. The tumour cells were arranged in compact nests (Fig. 2). The neoplastic cells were immunoreactive for cytokeratins type AE1–3 and neurone-specific enolase (NSE), whereas no staining was detected for S-100 protein, leukocyte common antigen, chromogranin, synaptophysin, vimentin and PSA (Fig. 3). The patient underwent chemotherapy with cisplatin (20 mg/m² on day 1–5) and etoposide (75 mg/m² on day 1–5) every 3 weeks. EBRT was planned 3 weeks later, using the box technique (lateral fields: x = 13.8 cm, y = 10 cm; anterior and posterior field: x = 15 cm, y = 10 cm). A dose of 58 Gy was delivered in 29 fractions (one fraction each day, five fractions a week) using 8 MV photons to an isocentric plan, with the patient supine. Four years later abdominal CT showed that the solid mass in the right seminal vesicle had disappeared (Fig. 4) and presently the patient is in good health.

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Small-cell carcinoma of the lung accounts for 18% of lung cancers. Usually it does not originate outside the lung, but in this exceptional case it originated in the seminal vesicle. This tumour is very rare and to our knowledge this is only the second report, and the first with a successful long-term response from chemotherapy and radiotherapy. In some patients affected by small-cell carcinomas of the prostate, chemotherapy allowed at most 8 months of survival [1]. Cancers of the seminal vesicle are very rare, with only 37 such cases reported [2,3]; a small-cell carcinoma of the seminal vesicle was reported previously in only one case, with treatment solely based on chemotherapy [4]. In the present patient a complete recovery was obtained using chemotherapy plus radiotherapy. Nevertheless, because the prognosis of this neoplasm is poor and it is rare we cannot confirm that such therapy should be considered the treatment of choice.

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