Primary leiomyosarcoma of the seminal vesicle: case report and review of the literature

Abstract

Background: Primary leiomyosarcoma of the seminal vesicle is exceedingly rare.

Case presentation: We report a case of a 59-year-old man with tumour detected by rectal symptoms and ultrasonography. Computed tomography and magnetic resonance imaging suggested an origin in the right seminal vesicle. Transperineal biopsy of the tumour revealed leiomyosarcoma. A radical vesiculo-prostactectomy with bilateral pelvic lymphadenectomy was performed. Pathological examination showed a grade 2 leiomyosarcoma of the seminal vesicle. The patient received adjuvant radiotherapy. He developed distant metastases 29 months after diagnosis, and received chemotherapy. Metastatic disease was controlled by second-line gemcitabine-docetaxel combination. Fifty-one months after diagnosis of the primary tumour, and 22 months after the first metastases, the patient is alive with excellent performance status, and multiple asymptomatic stable lung and liver lesions.

Conclusions: We report the eighth case of primary leiomyosarcoma of the seminal vesicle and the first one with a so long follow-up.

Figure 1

Magnetic resonance imaging of the pelvis. A/Coronal T2-weighted MRI showing an heterogeneous mass lesion in the region of right seminal vesicle, causing inferiorly and to the left displacement of the prostate (white arrow) and of the left seminal vesicle which appears normal (star). B/Axial contrast-enhanced T1-weighted MRI showing distinct margins between the mass and both the posterior wall of the bladder (black arrow) and the anterior wall of the rectum (white arrow).

Figure 2

Well-differentiated leiomyosarcoma. A/H&E staining showing intersecting fascicles of moderately atypical elongated cells with abundant eosinophilic cytoplasm. Mitoses (black arrows) are seen (original magnification X 200). B-D/Immunohistochemical analysis showing that tumour cells strongly express smooth-muscle actin (B, X 200) and H-caldesmone (C, X 200). 15% of the cells are stained by Ki-67 proliferative marker (D, X 200).

Figure 3

Response of lung metastases to gemcitabine-docetaxel chemotherapy. Chest CT-scan performed in October 2009 (A-B) and in August 2010 (C-D) showing partial response of lung metastases (arrows) after 9 cycles of second-line gemcitabine-docetaxel combination.