Synchronous prostate adenocarcinoma and Hodgkin lymphocytic lymphoma clinically manifested with lower urinary

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CLINICAL CASE
Synchronous prostate adenocarcinoma
and Hodgkin lymphocytic lymphoma
clinically manifested with lower urinary
tract symptomatology: a case report
and literature review
Acevedo-García Christian,1 Rosas RA,2 Rubio ZU,3 Roque RG,1 Arias LD.1
•Abstract
•Resumen
Of all malignant neoplasia only 0.2% are prostatic
hematologic neoplasia. They can be of primary origin or
secondary to hematogenic dissemination of myeloma,
lymphoma, or leukemia. Ten percent of non- Hodgkin
lymphoma affects the urinary tract but only one
percent affects the prostate. It is more frequent in men
over sixty years of age. The clinical case is described
of a 66-year-old man presenting with 30 kg weight
loss, asthenia, hyporexia, nocturia (two interruptions),
bladder tenesmus, straining, urinary frequency, dysuria,
and decrease in urinary stream flow, all six months prior
to consultation.
De todas las neoplasias malignas, sólo 0.2% son neoplasias hematológicas prostáticas, pueden ser de origen primario o secundario a una diseminación hematógena de
un mieloma, linfoma o leucemia. El linfoma no-Hogdkin
afecta en 10% al tracto urinario, pero sólo 1% a la próstata;
siendo más frecuente en varones mayores de 60 años. Se
presenta el caso clínico de un masculino de 66 años que
presentó desde seis meses previos a la visita, pérdida de
peso de 30 kg, astenia, hiporexia, nicturia dos ocasiones,
tenesmo vesical, pujo, polaquiuria, disuria y disminución
de la fuerza del chorro urinario.
Keywords: Adenocarcinoma of the prostate, tumor
synchronous. lymphocytic lymphoma, Mexico.
1 Urology Resident.
2 Head of Uro-oncology Ward.
3 Urology Service Staff Physician.
Hospital General de México, SSA, Mexico City.
182
Rev Mex Urol 2011;71(3):182-184
Palabras clave: Adenocarcinoma de prostata, tumor sincrónico, linfoma linfocitico, México.
Corresponding author: Dr. Christian Acevedo García. Dr. Balmis No.
148 Col. Doctores, Del. Cuauhtémoc, México D. F. Telephone: 2789
2000, Ext.: 1030. Email: raisha08@hotmail.com
Acevedo-García C, et al. Synchronous prostate adenocarcinoma and Hodgkin lymphocytic lymphoma clinically manifested with lower urinary
tract symptomatology: a case report and literature review
•Introduction
Lymphoma rarely infiltrates the prostate and represents
a rate of 1/1000 of all malignant prostate tumors.
Primary disease of the prostate from lymphoma is less
frequent (35%) than secondary prostatic lymphoma
(65%). It is frequent in non-Hodgkin lymphoma with its
known extranodal invasion. 1-3 Follicular lymphoma is
less frequent and infiltration by Burkitt’s lymphoma is
very rare. Lymphoma generally presents in the patient
around 60 years of age and can manifest as low urinary
tract symptomatology secondary to prostatic infiltration.
Symptomatology can include urinary urgency, urinary
frequency, hematuria, and acute urine retention.1,4-6
Lymphoma as primary tumor and a synchronous tumor
such as prostate adenocarcinoma is extremely rare.
Non- Hodgkin lymphoma infiltration to the prostate is
less than 1% and Hodgkin lymphoma is even lower. 5
However, it is rarely diagnosed and is more often only
reported in autopsies. 4,5 Prognosis is correlated with
histological type and extension towards the prostate. 4,7
•Objective
The objective of the present article was to describe a case
of prostate adenocarcinoma synchronous with Hodgkin
lymphocytic lymphoma that manifested clinically
with lower urinary symptomatology and to carry out a
literature review of the subject.
•Case presentation
Patient is a 66-year-old man with past medical history
of right inguinal hernioplasty 35 years prior and arterial
high blood pressure for which he is being treated. Present
disease onset was 6 months earlier, with weight loss of
30 kg, asthenia, hyporexia, nocturia (2 interruptions),
bladder tenesmus, straining, urinary frequency,
dysuria, and decrease in urinary stream flow. Physical
examination revealed tegument paleness, chest with no
alterations, palpable abdominal tumor that was hard,
fixed, approximately 10 x 10 cm, regular edges, located
in the mesogastrium. Inferior extremities had bilateral
infrapatellar edema, and pitting edema ++/+++. Digital
rectal examination (DRE) revealed 3 x 3 cm prostate
with increased consistency, mobile, well-defined edges,
euthermic, non-painful, suspicious, and with no lymph
nodes. Prostate specific antigen (PSA) was 6.46 ng/
dL, free PSA fraction 1.23 ng/mL, percentage of free
to total PSA, 19. Ultrasound-guided transrectal biopsy
of the prostate showed prostate of 2.7 x 2.4 x 3.4 cm
(11.5 cc), 12 g. Transrectal biopsy diagnosis was acinar
adenocarcinoma of the prostate, Gleason score 6
(3+3). Computed tomography scan revealed multiple
periaortic and retrocaval retroperitoneal adenopathies.
Image 1. Computed tomography scan taken of abdominal tumor
upon hospital admittance.
Beta 2 microglobulin was 3870 ng/mL. Excisional
biopsy from pelvic lymph node was taken that reported
probable metastatic carcinoma of retroperitoneal lymph
nodes with 70% metastatic cells and 30% lymphocytes.
Immunohistochemical studies reported classic Hodgkin
lymphocyte lymphoma with depletion-type lymphoid.
Chemotherapy was initiated based on dacarbazine
690 mg IV 2 sessions, adriamycin 46 mg IV single
dose, bleomycin 15 U IV and vinblastine 10 mg IV for
3 sessions. Postchemotherapy PSA was 0.97 ng/mL,
with free PSA fraction of 0.21 ng/mL without prostate
adenocarcinoma treatment (Images 1 and 2).
Tomographic reconstruction of abdominal mass is
presented corresponding to lymphoma before and after
chemotherapy (Images 3 and 4). Transverse views are
shown at the level of lymphoma invasion of the prostate
before and after chemotherapy.
•Discussion
Lymphoma presents in patients when they are around 60
years old. 1,2 Presentation is usually difficult to distinguish
because it includes emptying symptomatology
accompanied with fever, weight loss, hepatomegaly,
inguinal lymphadenopathy, and in only 20% of patients,
elevated PSA.1-4,6,7 Diagnosis is difficult because prostate
Rev Mex Urol 2011;71(3):182-184
183
Acevedo-García C, et al. Synchronous prostate adenocarcinoma and Hodgkin lymphocytic lymphoma clinically manifested with lower urinary
tract symptomatology: a case report and literature review
Image 2. Computed tomography scan
for lymphocytic lymphoma after chemotherapy.
Image 3. Views at prostate level before chemotherapy for lymphocytic
lymphoma.
biopsies have 22% sensitivity and so another urinary or
extraurinary primary origin must be detected. 7,8 More
than 60% of lymphoma patients die from the disease.
Survival at 10 years is possible with chemotherapy.1, 7-9
Bibliography
•Conclusions
3.
There are very few cases reported in the literature
of Hodgkin lymphocytic lymphoma that infiltrate the
prostate. Differential diagnosis including prostatitis,
leukemia, small cell carcinoma, pseudolymphoma,
Hodgkin lymphoma, and lymphoepithelioma needs to
be carried out in those patients that present with lower
urinary tract symptomatology.
1.
2.
4.
5.
6.
7.
8.
9.
184
Rev Mex Urol 2011;71(3):182-184
Image 4. Views at prostate level after
chemotherapy for lymphocytic lymphoma.
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