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Mantle cell lymphoma of the prostate.

Author(s): Abuhjar Abdussalam, MBChB, Ronald G. Gerridzen, MD, FRCSC, FACS

Case report

An 82-year-old man presented with increasing symptoms of bladder outlet obstruction. His medical history included repair of an abdominal aortic aneurysm in late 2005 followed by a brief period of urinary retention that spontaneously resolved. He also had hypercholesterolemia and diabetes. He had no family history of prostate cancer and his prostate-specific antigen (PSA) level was 2.4.

Cystoscopy demonstrated a moderately large prostate with a prominent middle lobe and a moderately trabeculated bladder with small diverticula. After medical therapy failed to improve his symptoms he underwent transurethral resection of the prostate. We resected 28 g of tissue with substantial clinical improvement. Microscopically, the tissue was substantially infiltrated by an atypical lymphoid infiltrate positive for CD20, BCL2, CD5 (weakly), κ light chain and cycline D1, consistent with mantle cell lymphoma (Fig. 1 and Fig. 2).

A computed tomography (CT) scan of his abdomen and thorax showed marked lymphadenopathy consistent with stage-IIIA mantle cell lymphoma. He had no constitutional or systemic symptoms. We referred him to a medical oncologist, and he received CHOP/Rituxan chemotherapy.

Discussion

Lymphoma of the prostate, either primary or secondary, is very rare. Most cases are diagnosed at autopsy. A 20-year review of 1474 patients with prostate cancer was completed at the MD Anderson Cancer Center; only 18 nonleukemic secondary cancers were identified.[sup.1] An autopsy series of 6000 male patients who died of cancer revealed only 185 (3.1%) with metastatic prostate cancer, of which only 49 (0.8%) had non-Hodgkins lymphoma.[sup.2] According to the criteria of Bostwick and colleagues,[sup.2] primary prostatic lymphoma will be diagnosed only if the following criteria are fulfilled: primary symptoms are attributable to prostatic enlargement; the major bulk of disease is localized to the prostate; and lymph nodes, liver or spleen are not involved within 1 month of diagnosis. Therefore, even though our patient presented with symptoms attributable to prostatic enlargement, he should be classified as having secondary prostatic lymphoma. Only 2 cases of mantle cell lymphoma involving the prostate have been reported. The first[sup.3] was reported in December 2003 from the Queen Mary Hospital, University of Hong Kong, and the second[sup.4] in February 2006 from Cleveland.

Conclusion

Our patient had a highly unusual presentation of mantle cell lymphoma involving the prostate. There were no other systemic manifestations of the primary disease, therefore the pathological findings were unsuspected.

Competing interests: None declared.

This paper has been peer-reviewed.

References

1.. Zein TA, Huben R, Lane W, et al. Secondary tumors of the prostate. J. Urol 1985;133:615-6.

2.. Bostwick DG, Iczkowski KA, Amin MB, et al. Malignant lymphoma involving the prostate: report of 62 cases. Cancer 1998;83:732-8.

3.. Chim CS, Loong F, Yau T, et al. Common malignancies with uncommon sites of presentation case 2: mantle cell lymphoma of the prostate gland. J Clin Oncol 2003;21:4456-8.

4.. Genkin I. Mantle cell lymphoma of prostate. Commun Oncol 2006;3:69.

Figures

Fig. 1.: Prostatic tissue infiltrated by an atypical lymphoid infiltrate under low and high power. [Figure omitted]

Fig. 2.: Prostatic tissue infiltrated by an atypical lymphoid infiltrate positive for CD5 (weak), Kappa light chain and cycline D1. [Figure omitted]

Author Affiliation(s):

[1] From the Division of Urology, Department of Surgery, University of Ottawa, Ottawa, Ont

Correspondence: Dr. Ronald G. Gerridzen, The Ottawa Hospital - Civic Campus, Division of Urology, B327, 1053 Carling Ave., Ottawa ON K1Y 4E9; rgerridzen@ottawahospital.on.ca
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Article Details
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Author:Abdussalam, Abuhjar; Gerridzen, Ronald G.
Publication:Canadian Urological Association Journal (CUAJ)
Article Type:Case study
Geographic Code:1CANA
Date:Dec 1, 2009
Words:680
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