Phyllodes tumor of the verumontanum: a case report

Abstract

The current report presents the case of a 42-year-old male with extraordinarily salient urination difficulty that had lasted 6 months. Transrectal ultrasonography and pelvic magnetic resonance imaging demonstrated prostatic hyperplasia and cyst. PSA level was 20.65 (>4) μg/L in the patient. Transrectal prostatic biopsy revealed benign prostatic hyperplasia. He agreed to receive plasmakinetic resection of the prostate. During operation a lobulated lump was unexpectedly found on the verumontanum, with the prostate macroscopically normal. Complete tumor excision was performed and pathological assessment indicated phyllodes tumor of the verumontanum. The patient had an uneventful post-operative course and recovered well. The diagnosis, histological classification, treatment, and prognosis of this case are presented. It is necessary to perform cystoscopy to exclude verumontanum tumor even when all imaging examinations indicate prostate hyperplasia, especially in young males. Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1868931661161758.

Fig. 1

MRI—Transverse section. T2 weighted phase. Multiple nodules of long T2 signal are visible in the right area of the prostate

Fig. 2

MRI—Sagittal section. T2 weighted phase. Bump of posterior urethral extruding to the bladder

Fig. 3

Intraoperative view. A papillary lobulated lump with intact surface was found during the operation, acting as a valve for the bladder outlet

Fig. 4

Intraoperative view. The lump was connected to the verumontanum by a pedicle

Fig. 5

Microscopic assessment of the tumor revealed an epithelial-stromal tumor, including irregular-shaped benign glandular elements and excessive hyperplasia of stromal tumor cells. Stromal cells exhibit pleomorphism, and were multinucleated and giant (hematoxylin and eosin; original magnification × 200)

Fig. 6

An irregular cleft like space is lined by epithelium and invested with cellular stroma (H & E, original magnification × 200)

Fig. 7

A total of 500 cells were counted at the most intense Ki-67-stained area for the assessment of Ki-67 positivity(100 × magnification)