Adenocarcinoma of the seminal vesicle
Adenocarcinomas of the seminal vesicles are the most common malignant primary neoplasm of the seminal vesicles.
Primary adenocarcinoma of the seminal vesicles are very rare 1,2 and can be observed at a wide age range 2.
There is a lack of specific symptoms and therefore patients usually present with advanced stages.
Haematospaermia, hematuria, dysuria other obstructive symptoms, or pelvic pain are possible forms of presentation with digital rectal examination the only clinical examination which is able to indicate the presence of a tumor in the seminal vesicles in up to 30% 1-4.
Primary adenocarcinoma of the seminal vesicles tends to metastasize to pelvic, paraaortic and other lymph nodes as well as to the lungs and liver. Other sites of metastases including bone have been reported 1.
The following modified criteria have been described for the diagnosis 2:
- main tumor localization in the seminal vesicle
- seminal vesicle invasion by other cancers needs to be excluded (e.g. PSA, PAP and CEA negative)
- preferable papillary growth pattern resembling the seminal vesicle architecture
Tumors are required to be mainly or exclusively localized in the seminal vesicle 1,4.
Microscopically tumors need to be consistent with adenocarcinomas 4. Histological features include 2:
- hobnail appearance of tumor cells
- transparent cytoplasm
- papillary glandular architecture
CA-125 is usually elevated in primary adenocarcinoma of the seminal vesicles and rarely normal, whereas prostate specific antigen (PSA), prostate-specific acid phosphatase (PSAP) and CEA are usually normal 1-3.
Magnetic resonance imaging and computed tomography and have been mainly used for the visualization of the seminal vesicles 1,2. Seminal vesicle adenocarcinomas are usually circumscribed and confined or mainly located in the seminal vesicles and might appear solid or cystic 3,4.
CT findings include various descriptions of solid heterogeneously enhancing masses centered around the seminal vesicles 1,3.
Findings on MRI have been reported with heterogeneous and lobulated features as papillary or cystic necrotic with solid components and often high signal in T1 weighted images 1-4.
PET-CT shows FDG-uptake in the primary tumor and has been used for the diagnosis, staging and evaluation of treatment 1-3.
The radiological report should include a description of the following:
- form, location and size of the tumor
- tumor margins
- prostatic invasion
- bladder invasion
- suspicious or enlarged lymph nodes
Treatment and prognosis
Management is usually multimodal including radical surgery in combination with radiation therapy hormone and chemotherapy 1. Prognosis is considered poor with the vast majority of patients dying in less than 3 years probably party due to the advanced stage at the time of diagnosis in most cases 1-4.
History and etymology
Primary adenocarcinoma of the seminal vesicles was first reported by O. Lyons in 1925 1,2. Dalgaard and Giertson initially described the criteria for the diagnosis in 1956 1 which were later modified 2.
Conditions mimicking the clinical presentation or imaging appearance of prostatic urothelial carcinoma include 1:
- 1. Katafigiotis I, Sfoungaristos S, Duvdevani M, Mitsos P, Roumelioti E, Stravodimos K, Anastasiou I, Constantinides CA. Primary adenocarcinoma of the seminal vesicles. A review of the literature. (2016) Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 88 (1): 47-51. doi:10.4081/aiua.2016.1.47 - Pubmed
- 2. Eken A, Izol V, Aridogan IA, Erdogan S, Acıkalın A, Tansug Z. An unusual cause of hematospermia: Primary adenocarcinoma of the seminal vesicle. (2012) Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 6 (6): E259-62. doi:10.5489/cuaj.11132 - Pubmed
- 3. Sollini M, Silvotti M, Casali M, Giovanardi F, Zadro A, Froio A, Erba PA, Versari A. The role of imaging in the diagnosis of recurrence of primary seminal vesicle adenocarcinoma. (2014) The world journal of men's health. 32 (1): 61-5. doi:10.5534/wjmh.2014.32.1.61 - Pubmed
- 4. Li Y, Mongan J, Behr SC, Sud S, Coakley FV, Simko J, Westphalen AC. Beyond Prostate Adenocarcinoma: Expanding the Differential Diagnosis in Prostate Pathologic Conditions. (2016) Radiographics : a review publication of the Radiological Society of North America, Inc. 36 (4): 1055-75. doi:10.1148/rg.2016150226 - Pubmed
- 5. Reddy MN, Verma S. Lesions of the Seminal Vesicles and their MRI Characteristics. (2014) Journal of clinical imaging science. 4: 61. doi:10.4103/2156-7514.143734 - Pubmed