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Presented by Dr. Jonathan Epstein and prepared by Dr. Robby Jones.
A 70 year old man underwent a radical prostatectomy for a lesion that was restricted in location to the seminal vesicles.
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A 70 year old man underwent a radical prostatectomy for a lesion that was restricted in location to the seminal vesicles.
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C) Malignant mixed epithelial and stromal tumor of the seminal vesicle
Histological Description: A predominantly solid with focal cystic areas replaces the seminal vesicle. The solid areas by mixed epithelioid and spindled pleomorphic cells without specific differentiation. Towards the luminal surface of the cystic areas the lining is composed of seminal vesicle type epithelium as are subjacent small entrapped tubules. Focally, there are polypoid projections of the epithelial and stromal tumor into the cystic spaces.
Discussion: Primary tumors of the seminal vesicles are rare and can only be diagnosed at resection where it is demonstrated that there is no primary site in the prostate, bladder, or adjacent GI tract, as there is nothing specific about the histology of seminal vesicle tumors. Of mesenchymal tumors primary to the seminal vesicles, leiomyosarcoma is the most common. Even poorly differentiated leiomyosarcomas retain a fascicular growth pattern in areas with fascicles appearing in both longitudinal and cross-section. There is a group of spindle cell tumors of the seminal vesicles that have both an epithelial and stromal component that have been variable named in the past but more recently designated as mixed epithelial and stroma tumors, analogous to lesions in the kidney. Roughly 7 cases of low-grade mixed epithelial-stromal tumor primary in the seminal vesicle have been recognized Microscopically, there is a biphasic pattern, sometimes with leaf-like projections. The epithelial component is characterized by variable-sized glandular spaces with a simple cuboidal to columnar lining, which can be flattened in some cysts. There is mild cytological atypia with little to no mitotic activity in the epithelium. Intracytoplasmic pigment as seen in normal seminal vesicle epithelium may be visible. The stromal element is composed of spindle cells which can show focal cytologic atypia, and focal high cellularity with a tendency to condense around distorted glands. Mitotic activity is low, at 0 to 1 per 10 high-power fields or 1-2%. There are only 2 reports of malignant mixed epithelial stromal tumors, as seen in the current case. In high-grade epithelial-stromal tumors, in contrast, the stroma shows overgrowth, cytologic anaplasia, marked cellularity, necrosis, and frequent mitoses. Both high grade mixed epithelial and stromal tumors eventually metastasized.
Incorrect
C) Malignant mixed epithelial and stromal tumor of the seminal vesicle
Histological Description: A predominantly solid with focal cystic areas replaces the seminal vesicle. The solid areas by mixed epithelioid and spindled pleomorphic cells without specific differentiation. Towards the luminal surface of the cystic areas the lining is composed of seminal vesicle type epithelium as are subjacent small entrapped tubules. Focally, there are polypoid projections of the epithelial and stromal tumor into the cystic spaces.
Discussion: Primary tumors of the seminal vesicles are rare and can only be diagnosed at resection where it is demonstrated that there is no primary site in the prostate, bladder, or adjacent GI tract, as there is nothing specific about the histology of seminal vesicle tumors. Of mesenchymal tumors primary to the seminal vesicles, leiomyosarcoma is the most common. Even poorly differentiated leiomyosarcomas retain a fascicular growth pattern in areas with fascicles appearing in both longitudinal and cross-section. There is a group of spindle cell tumors of the seminal vesicles that have both an epithelial and stromal component that have been variable named in the past but more recently designated as mixed epithelial and stroma tumors, analogous to lesions in the kidney. Roughly 7 cases of low-grade mixed epithelial-stromal tumor primary in the seminal vesicle have been recognized Microscopically, there is a biphasic pattern, sometimes with leaf-like projections. The epithelial component is characterized by variable-sized glandular spaces with a simple cuboidal to columnar lining, which can be flattened in some cysts. There is mild cytological atypia with little to no mitotic activity in the epithelium. Intracytoplasmic pigment as seen in normal seminal vesicle epithelium may be visible. The stromal element is composed of spindle cells which can show focal cytologic atypia, and focal high cellularity with a tendency to condense around distorted glands. Mitotic activity is low, at 0 to 1 per 10 high-power fields or 1-2%. There are only 2 reports of malignant mixed epithelial stromal tumors, as seen in the current case. In high-grade epithelial-stromal tumors, in contrast, the stroma shows overgrowth, cytologic anaplasia, marked cellularity, necrosis, and frequent mitoses. Both high grade mixed epithelial and stromal tumors eventually metastasized.
