Concurrent occurrence of adenocarcinoma and urothelial carcinoma of the prostate gland: A case report

Abstract

Background: Adenocarcinoma is the most common subtype of prostate cancer. Prostatic urothelial carcinoma (UC) typically originates from the prostatic urethra. The concurrent occurrence of adenocarcinoma and UC of the prostate gland is uncommon.

Case summary: We present the case of an 82-year-old male patient with simultaneous adenocarcinoma and UC of the prostate gland. The patient underwent a transrectal ultrasound-guided biopsy, and the pathology test revealed UC. Subsequently, transurethral laser prostatectomy was performed, and the pathology test indicated adenocarcinoma of the prostate with a Gleason score of 3 + 4 and high-grade UC. Therefore, the patient was treated with androgen deprivation therapy, systemic chemotherapy, and immunotherapy. Magnetic resonance imaging performed during follow-up revealed a prostate tumor classified as cT2cN1M0, stage IVA. Therefore, the patient underwent robotic-assisted radical prostatectomy and bilateral pelvic lymph node dissection. The final pathology test of the prostate gland revealed acinar-type adenocarcinoma, Gleason pattern 4 + 3, pT2N0M0, and high-grade UC. The patient regularly presented to the clinic for postoperative follow-up evaluations. He did not experience any urinary discomfort.

Conclusion: According to our literature review, this is the first reported case of coexisting adenocarcinoma and UC of the prostate gland.

Keywords: Adenocarcinoma; Case report; Coexist; Prostate; Urothelial carcinoma.

Figure 1

Fishbone diagram of treatment. ADT: Androgen deprivation therapy; BPLND: Bilateral pelvic lymph node dissection; TRUS: Transrectal ultrasound.

Figure 2

Image of the pelvis obtained during follow-up with magnetic resonance imaging. A: A 2.4-cm lesion with low T2 signal is observed in the posterolateral portion of the left transitional zone; B: Apparent diffusion coefficient of the lesion with low signal; C: Increased diffusion tensor imaging signals are observed.

Figure 3

Technetium-99m methylene diphosphonate whole-body bone scan. Focal areas of increased radioactivity uptake are noted in the lumbar spine at levels L1/2, L3/4, and L4/5, as well as in the left elbow and bilateral acromioclavicular joints. These findings suggest a benign etiology.

Figure 4

Images obtained during an 18F-fluorodeoxyglucose positron emission tomography evaluation of the region comprising the head to the upper thigh. From left to right: Ill-defined fluorodeoxyglucose (FDG) avidity is observed in the prostate; No FDG-avid regional or distant lymph nodes are apparent; Ill-defined FDG avidity is noted in the right buccal region after the dental prosthesis; and Ill-defined FDG avidity in the right T1, T4, T8, T12, and left upper ilia with sclerotic changes, suggesting a benign etiology.

Figure 5

Gross examination of the prostate tumor after robotic-assisted radical prostatectomy. 4 cm × 3 cm × 4 cm prostate gland with a volume of 24.96 mL and weight of 29 g; The 19 cm × 1.3 cm × 0.7 cm adenocarcinoma is located in the left anterior lateral lobe and, specifically, in the middle area transitioning to the peripheral zone. The 1 cm × 0.6 cm × 0.6 cm carcinoma of the urethra is observed in the right posterior lobe, middle area, and near the periurethra.

Figure 6

Histopathological analysis and immunohistochemical examination of the resected specimen. A: Adenocarcinoma of the prostate (hematoxylin and eosin staining × 100); B: Positive immunohistochemical (IHC) staining for α-methylacyl coenzyme A racemase ( × 200); C: Prostate urothelial carcinoma (hematoxylin and eosin staining × 100); D: Positive IHC staining for GATA binding protein 3 ( × 40).