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Seminal Vesicle Carcinoma

Primary seminal vesicle carcinoma is an exceedingly rare carcinoma arising in the seminal vesicle; its diagnosis requires exclusion of direct invasion or metastasis from the prostate, bladder, rectum, or another primary tumor.

Pathology

Histologically, primary seminal vesicle carcinoma is an adenocarcinoma that does not express PSA. Expression of CEA and CA-125, together with absence of prostate-specific markers such as PSA, PSAP, and NKX3.1, is typical. Rare tumors include sarcomas, carcinoids, cystosarcoma phyllodes, and primary seminomas (Thiel and Effert, 2002).

Clinical Presentation

Pain, hematospermia, hematuria, dysuria, obstructive voiding symptoms, and hydronephrosis; many patients become symptomatic only at a locally advanced stage.

Diagnosis

Prostatic, urothelial, and colorectal primary tumors must be excluded clinically and immunohistochemically.

Tumor Markers

PSA is not significantly elevated; CEA and CA-125 may be elevated.

TRUS

TRUS with biopsy.

Staging

MRI or CT of the pelvis and abdomen and chest CT.

Differential Diagnosis

More common entities include benign masses such as adenomas, cystadenomas, fibromas, leiomyomas, cysts, and abscesses, as well as secondary invasion by carcinomas of the prostate, bladder, or rectum.

Treatment

In the absence of prospective studies, no standard treatment exists. For localized disease, complete surgical resection is pursued, commonly by radical prostatectomy, cystoprostatectomy, or pelvic exenteration, depending on organ involvement. Adjuvant radiotherapy or systemic therapy is selected individually according to resection status, extent of disease, and histology. Antiandrogen therapy is reasonable for advanced androgen receptor-positive tumors.

References

Thiel und Effert 2002 THIEL, R. ; EFFERT, P.: Primary adenocarcinoma of the seminal vesicles.
In: J Urol
168 (2002), Nr. 5, S. 1891–6

  Deutsche Version: Samenblasenkarzinom

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