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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 1  |  Page : 194-195
Primary diffuse large B-cell lymphoma of the prostate presenting as urinary retention


Department of Pathology, Kasturba Medical College, Mangalore, Karnataka, India

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Date of Web Publication19-Jan-2010
 

How to cite this article:
Kini JR, Kini H, Pai MR, Naik R. Primary diffuse large B-cell lymphoma of the prostate presenting as urinary retention. Indian J Pathol Microbiol 2010;53:194-5

How to cite this URL:
Kini JR, Kini H, Pai MR, Naik R. Primary diffuse large B-cell lymphoma of the prostate presenting as urinary retention. Indian J Pathol Microbiol [serial online] 2010 [cited 2019 Oct 17];53:194-5. Available from: http://www.ijpmonline.org/text.asp?2010/53/1/194/59238


Sir,

Prostatic involvement in non-Hodgkin lymphoma is rare but well documented. [1],[2],[3],[4],[5] Of the primary malignancies involving the prostate, adenocarcinoma is the most common and lymphoma the rarest. The latter accounts for 0.09% of prostatic neoplasms and 0.1% of all non-Hodgkin lymphomas. [1] We report a primary prostatic lymphoma in an elderly male presenting with acute retention of urine.

An 88-year-old man presented with acute retention of urine of one-day duration, with prior history of prostatism. At the time of admission, he had suprapubic tenderness and the bladder was distension. Digital rectal examination revealed non-tender, firm and smooth grade III prostatomegaly. On sonological evaluation, the prostate weighed 65 grams, had homogenous texture and specks of calcification. There was no other organomegaly, lymphadenopathy or enlargement of lymph nodes in the abdominal cavity or mediastinum. Laboratory investigations revealed hemoglobin of 9.7gm/dl, neutrophilia and serum prostate specific antigen of 9. 4 ng/ml. A transurethral resection of the prostate was performed.

Histopathological examination revealed dense monomorphic non-contiguous aggregates of atypical lymphocytes, extensively infiltrating the prostatic stroma. [Figure 1] There was relative preservation of intervening prostatic ducts and acini. The malignant cells were leukocyte common antigen (LCA) and CD 20 positive and negative for CD 3 [Figure 2], confirming the B cell lineage of these cells. A final diagnosis of non-Hodgkin lymphoma, diffuse B cell type was made. A repeat abdominal ultrasonogram was followed by computed tomography (CT) scan abdomen and pelvis [Figure 3].

The patient refused further treatment. At the three month follow-up visit there was no other hematological abnormality except for low hemoglobin. CT scan of the thorax and abdomen showed mild hepatosplenomegaly with enlarged para- and preaortic lymph nodes. The patient expired six months after diagnosis. Primary prostatic lymphoma without lymph node involvement is much less common than secondary involvement of the prostate accounting for 0.09% of prostate neoplasms. [1],[2] Patients are elderly men presenting with symptoms related to prostatic enlargement including urgency, frequency, occasional hematuria or acute urinary retention. [1],[2] These cases are most often attributed to benign prostatic hyperplasia or prostatic carcinoma.

Bostwick and Mann [2] proposed the diagnostic criteria for primary lymphoma of the prostate which includes symptoms attributable to prostatic enlargement, lymphoma chiefly involving the prostate with or without involvement of adjacent tissue and lack of liver, spleen, lymph node and peripheral blood involvement within one month of diagnosis. Primary prostatic lymphoma can be confidently diagnosed on histopathological examination and by employing ancillary methods such as immunohistochemistry. The chief histological differential diagnoses include chronic prostatitis with follicular hyperplasia, and chronic lymphocytic leukemia. The histological types of lymphoma include diffuse large B cell lymphoma, small cell lymphocytic, diffuse small cleaved, mixed small and large cell, immunoblastic T cell type, mucosa associated lymphoid tissue (MALT) lymphoma and Hodgkin disease. [1],[2],[4],[5]

The overall prognosis in prostatic lymphoma is poor. [1],[2] More than 60% patients' die of lymphoma although survival up to 10 years is possible with combination chemotherapy. Prostatic lymphoma has been treated with combination of chemotherapy and radiotherapy. Surgery is used chiefly for symptomatic relief of urinary obstruction.

In conclusion, elderly men with obstructive symptoms and normal prostate specific antigen (PSA) level rarely have a prostatic lymphoma that pathologists need to diagnose to facilitate appropriate management of these patients.

 
   References Top

1.Bostwick DG, Iczkowski KA, Amin MB, Discigil G, Osborne B. Malignant Lymphoma Involving the Prostate. Report of 62 Cases. Cancer 1998;83:732-8.   Back to cited text no. 1      
2.Bostwick DG, Mann RB. Malignant Lymphomas Involving the Prostate. A Study of 13 Cases. Cancer1985;56:2932-8.  Back to cited text no. 2      
3.Alvarez CA, Rodriguez BI, Perez LA. Primary Diffuse large B-cell Lymphoma of the Prostate in a Young Patient. Int Braz J Urol 2006;32:64-5.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Tissier F, Badoual C, Saporta F, Guymar S, Delfau-Larue MH, Zerbib M, et al. Prostatic lymphoma of mucosa-associated lymphoid tissue: an uncommon location. Histopathology 2002;40:111-3.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Antunes AA, Dall'Oglio M, Srougi M. Primary Lymphoma of the Prostate: A rare cause of urinary obstruction. Int Braz J Urol 2004;30:410-2.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  

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Correspondence Address:
Jyoti Ramnath Kini
Department of Pathology, Kasturba Medical College, Mangalore, Karnataka-575 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.59238

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  [Figure 1], [Figure 2], [Figure 3]



 

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