Primary lymphoma of the prostate: a rare cause of urinary obstruction

CASE REPORT

Primary lymphoma of the prostate: a rare cause of urinary obstruction

Alberto A. Antunes; Marcos Dall’Oglio; Miguel Srougi

Discipline of Urology, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil

^{Correspondence}

ABSTRACT

Primary lymphoma of the prostate is rare. It represents 0.09% of prostate neoplasias. The authors report the case of a 42-year old patient presenting urinary obstruction and renal failure due to primary lymphoma of the prostate.

We discuss the clinical manifestations of this disease, iphasizing that systiic chiotherapy represents the initial and preferential therapeutic method

Key words: prostatic neoplasms; lymphoma; ureteral obstruction

INTRODUCTION

Primary lymphoma of the prostate is rare. It represents 0.09% of prostate neoplasias and 0.1% of all non-Hogdkin lymphomas (1). Secondary involvient of the gland is the most common presentation in such cases (2).

The authors report the case of a patient presenting infravesical obstruction and renal failure resulting from prostate lymphoma, and discuss the main clinical features of this rare neoplasia.

CASE REPORT

A 42-year old man was seen at our service, complaining of weak urinary stream and dysuria for 10 days. Digital rectal examination showed a voluminous prostate with fibroelastic consistency. Blood testes revealed PSA of 0.7 ng/mL and serum creatinine of 3.6 mg/dL.

An ultrasonography of the urinary tract showed a 286-gram prostate with moderate bilateral uretero-hydronephrosis. Nuclear resonance imaging was normal in thorax, but the abdominal and pelvic scan evidenced a voluminous expansive and infiltrative lesion exclusive of the prostate, with intense impregnation, measuring 10 x 8 cm (Figure-1), bilateral uretero-hydronephrosis, and absence of lymph nodal involvient. Bone scintigraphy was negative for secondary lesions. Patient evolved to anuria, and subsequently underwent bilateral nephrostomy.

Prostate biopsy was performed, identifying a diffuse large cell lymphoma, whose immunohistochiical test was positive for antibodies CD45 (UCHL1–DAKO) and CD20 (L26–DAKO), characterizing B-cell lymphoma (Figure-2). Using the King & Cox modified criteria, the diagnosis of primary extranodal lymphoma of the prostate was confirmed (stage IAE) (1).

Patient initiated cytotoxic chiotherapy with cyclophosphamide, doxorubicin, vincristine and etoposide. After the second cycle, he showed significant clinical and laboratorial improvient, with spontaneous voiding and creatinine levels of 1.5 mg/dL.

COMMENTS

Approximately one third of non-Hodgkin lymphomas occur in extranodal sites. Primary lymphomas of the prostate represent 0.1% of cases, and many times, it is incidentally found following prostate surgery for resolving bladder obstruction (1).

Primary lymphomas of the prostate occur in men aged 60 years in average. The most frequent presentation forms are obstructive urinary symptoms, and obstruction can lead to renal failure (1-3). The occurrence of systiic symptoms such as fever or weight loss, identification of hepatosplenomegaly and inguinal lymphadenopathy on physical examination, or changes in laboratory tests are uncommon. The digital rectal examination can reveal an extriely enlarged prostate with normal consistency, with unaltered PSA (2).

The definition of primary lymphoma of the prostate is based in several criteria. The main symptoms are urinary, the disease occurs predominantly in the prostate, with or without extension to adjacent tissues and there is no involvient of lymph nodes, liver, spleen or blood up to 1 month after diagnosis (3).

Several therapeutic modalities have been reported, including prostatectomy, radiotherapy, chiotherapy, and even cystoprostatectomy (1,2). However, the best therapeutic approach for primary lymphoma of the prostate is chiotherapy based on doxorubicin (3). Among the 23 cases of primary lymphoma of the prostate reported on the Japanese literature, 3 of 5 cases treated with radiotherapy or radical prostatectomy resulted in death or progression of disease. On the other hand, 11 out of 16 cases (69%) that received chiotherapy alone or associated with other treatments had a full response (3).

The authors conclude that prostate lymphomas, despite being rare, must be included in differential diagnostic of cases with obstruction of the lower urinary tract, especially in patients with exaggerated enlargient of the gland and previous history of lymphoma in other sites. Chiotherapy constitutes the primary therapeutic approach.

Received: July 20, 2004

Accepted after revision: August 12, 2004

• 1. Sarris A, Dimopoulos M, Pugh W, Cabanillas F: Primary lymphoma of the prostate: good outcome with doxorubicin-based combination chiotherapy. J Urol. 1995; 153: 1852-4.
• 2. Bostwick DG, Mann RB: Malignant lymphomas involving the prostate. A study of 13 cases. Cancer. 1985; 56: 2932-8.
• 3. Fukutani K, Koyama Y, Fujimori M, Ishida T: Primary malignant lymphoma of the prostate: report of a case achieving complete response to combination chiotherapy and review of 22 Japanese cases. Nippon Hinyokika Gakkai Zasshi. 2003; 94: 621-5.

Publication Dates

• Publication in this collection
  24 Nov 2004
• Date of issue
  Oct 2004

History

• Received
  20 July 2004
• Accepted
  12 Aug 2004