[Co-occurrence of multilocular prostatic cystadenoma and incidental low-risk adenocarcinoma in a young male patient].

Abstract

In the background of the urinary symptoms of a young, 31-year-old male patient pelvic MRI revealed a multilocular cystic tumor measuring 7.6 cm in diameter on the right side of the pelvis. Given his symptoms and the possibility of malignancy, a transperitoneal laparoscopic resection was performed. Histological examination confirmed the diagnosis of prostatic cystadenoma, and an incidental finding of Gleason-grade 3 + 3 adenocarcinoma was also noted in a small focus. Postoperatively, the patient became completely asymptomatic, with neither urinary symptoms nor erectile/ejaculatory dysfunction. A follow-up MRI performed 3 months later showed no recurrence, and PSA levels showed significant regression. The patient continues to be monitored closely. The prostatic cystadenoma is an exceedingly rare benign tumor, with fewer than 50 cases reported to date. Preoperative diagnosis is challenging due to the nonspecific nature of its compressive urogenital and gastrointestinal symptoms. Basic investigations, such as physical examination, ultrasound and PSA testing, are often uninformative. More detailed diagnostic information can be obtained through higher-order imaging studies (CT, pelvic MRI) or cytological/histological sampling via fine needle or core biopsy. The treatment of prostatic cystadenoma is primarily surgical, involving resection or excision through various approaches (transurethral, laparoscopic, robotic, or open surgery). Complete removal of the tumor is crucial, as incomplete resection is associated with high rate of recurrence. Although prostatic cystadenomas typically exhibit indolent behavior, a case of concurrent high-grade prostatic intraepithelial neoplasia and a further description of conventional adenocarcinoma have been already published. This case is noteworthy as it represents the second documented co-occurrence of prostatic cystadenoma and adenocarcinoma (collision tumor), according to the current literature. Orv Hetil. 2024; 165(52): 2065–2071.