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CASE REPORT Table of Contents   
Year : 2002  |  Volume : 12  |  Issue : 1  |  Page : 75-77
Primary adenocarcinoma of seminal vesicles


Department of Radiology, Rajiv Gandhi Cancer Institute & Research Centre, Sector-5, Rohini, Delhi-85, India

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Keywords: Seminal Vesicle, Tumour, PSA, Prostate, CT, MRI

How to cite this article:
Chhabra A, Bhullar S S, Oberoi R, Chaturvedi A K, Rao S A. Primary adenocarcinoma of seminal vesicles. Indian J Radiol Imaging 2002;12:75-7

How to cite this URL:
Chhabra A, Bhullar S S, Oberoi R, Chaturvedi A K, Rao S A. Primary adenocarcinoma of seminal vesicles. Indian J Radiol Imaging [serial online] 2002 [cited 2019 Jul 20];12:75-7. Available from: http://www.ijri.org/text.asp?2002/12/1/75/28421
Primary Tumors of the Seminal Vesicles are rare. Many of the reported cases probably represent invasion from carcinoma originating in other sites,

particularly the prostate gland. We present the Computed Tomographic (CT) and Magnetic resonance Imaging (MRI) findings in a 60-year-old man with a pathologically proven primary adenocarcinoma of the seminal vesicles. The role of MRI and Immunohistochemistry in the diagnosis is emphasized.


   Case report Top


A sixty year old man presented with complaints of urgency, weak urinary stream and occasional blood in the seminal fluid for the last two months. Per-rectal examination revealed firm enlarged prostate with periprostatic thickening. On cystoscopy, prostatic urethra and bladder neck were hyperaemic. Urinary bladder wall was trabeculated.

Contrast enhanced CT of the whole abdomen was performed [Somatom AR, Siemens, Germany]. The CT scan showed an irregular soft tissue mass involving the seminal vesicles, more on the right side, with thickening of the posterior urinary bladder wall and infiltration of the right vesico-ureteric junction. Obliteration of the seminal vesicle angle was seen on the right side [Figure - 1],[Figure - 2]. Mild right sided hydronephrosis was also seen.

Following CT, MRI of the Pelvis was performed using 5mm T1W SE and T2W TSE sequences, obtained in the axial and sagittal planes [Magnetom Impact, 1Tesla, Siemens, Germany]. The MRI showed similar findings with a mass involving the seminal vesicles, appearing isointense to muscle in T1W images and iso to hypointense in T2W images [Figure - 3],[Figure - 4]. Involvement of the base of the urinary bladder and prostate was better seen [Figure - 5]. In addition, few small right external iliac lymph nodes were also visualized.

On surgery, a growth involving both seminal vesicles was found. It was adherent to the prostate and to the base of the urinary bladder. Hard small lymph nodes were seen in the right external iliac and obturator regions.

On pathological examination, a tumour comprising of malignant epithelial cells was seen infiltrating the complete thickness of the wall of the seminal vesicles. Infiltration of the prostate and in one section of the wall of the urinary bladder was present. The right obturator and external iliac lymph nodes showed metastatic deposits. On immunohistochemistry, the tumour cells were prostate specific antigen (PSA) negative. The final pathological diagnosis was - Moderately differentiated adenocarcinoma of the seminal vesicles with infiltration of the prostate, bladder wall and metastases to pelvic lymph nodes.


   Discussion Top


The normal seminal vesicle measures 4.5-5.5 cm in length and 2cm in width [1]. Asymmetry of the seminal vesicles can be seen among normal subjects but signal intensity is symmetric on both T1 and T2W images.

Primary carcinomas of seminal vesicles are pathologic curiosities. The most common form of tumour affecting the seminal vesicles is invasion by prostate cancer [2]. To make the diagnosis of primary tumour in seminal vesicles radiologically, the epicenter of the mass should be in the seminal vesicles and immunohistochemistry should show PSA negativity on tumour cells [3]. The only cells reported to be staining to PSA apart from the prostate gland, are female paraurethral gland cells [4]. Histologically, adenocarcinoma is the most common tumour. Other reported types are leiomyosarcoma, phyllodes tumour, choriocarcinoma, mullerian tumour and angiosarcoma [3].

In secondary spread from the prostate, early involvement of seminal vesicles is indicated by thickening of the tubal walls as seen on MRI. At a later stage, intraluminal low signal intensity foci can be seen on T2W images as well as loss of seminal vesicle angle. But imaging findings of primary adenocarcinoma of the seminal vesicles are unreported. We believe recognition of changes in signal intensity of the seminal vesicles is a more sensitive indicator of primary tumour than changes in their size similar to what is described for secondary invasion of seminal vesicles from prostate[5]. The differential diagnosis of signal changes are-post biopsy bleed, post-radiation and hormone therapy changes and rarely amyloid deposits or calcification [6],[7]. All these may cause the signal intensity of the seminal vesicles to be lower on T2W images.

In conclusion, primary adenocarcinoma of the seminal vesicles is a rare entity. However, in a given clinical context especially with a history of hematospermia, if the epicenter of a mass is in the seminal vesicles with minimal or no involvement of the adjacent organs particularly the prostate gland, diagnosis can be suggested. MRI provides better evaluation of prostatic involvement than CT due to superior soft tissue resolution. Diagnosis is further substantiated pathologically if PSA negativity is shown in the tumour cells.

 
   References Top

1.Morris HB. Human anatomy: The urogenital system, 11th ed, New York, Mc Graw-Hill, 1992.  Back to cited text no. 1    
2.Robert R. Edelman. Clinical Magnetic resonance Imaging: Male pelvis, 2nd ed, Philadephia, W.B. Saunders Company, 1996.  Back to cited text no. 2    
3.Juan Rosai. Ackerman's surgical pathology: 8th ed, Mosby. Yearbook, Inc. 1996.  Back to cited text no. 3    
4.Pollen JJ et al. Oncology: Immunohistochemical identification of prostatic acid phosphatase and PSA in female paraurethral glands. Urology 1984; 23: 303-4.  Back to cited text no. 4    
5.Joseph K.T. Lee. Computed Body Tomography with MRI correlation: Pelvis, 3rd ed, Philadelphia, Lippincott - Raven Publishers, 1998.  Back to cited text no. 5    
6.Parvati Ramchandani, Mitchell D. Schnall Virginia A. Livolsi, John E. Tomaszewski and Howard M. Pollack. Senile amyloidosis of the seminal vesicles mimicking metastatic spread of prostatic carcinoma on MR images. AJR 1993; 161: 99-100.  Back to cited text no. 6    
7.Eduardo Secaf, Regina N. Nuruddin, Hedvig Hricak, R. Dale McClure, and Barbara Demas. MR Imaging of the seminal vesicles. AJR 1991; 16: 989-994  Back to cited text no. 7    

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Correspondence Address:
A Chhabra
Department of Radiology, Rajiv Gandhi Cancer Institute & Research Centre, Sector-5, Rohini, Delhi-85
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

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