Primary seminal vesicle adenocarcinoma with a history of seminal vesicle cyst:A case report and review of literature

BACKGROUND Primary seminal vesicle adenocarcinoma is a rare malignancy that is difficult to diagnose.CASE SUMMARY A 54-year-old man with an 18-year history of a seminal vesicle cyst presented with worsening hematospermia that had persisted for one month.Dynamic contrast-enhanced computed tomography and pelvic magnetic resonance imaging indicated a mass with a cystic-solid component.Robot-assisted seminal vesicle tumor resection was performed,and primary seminal vesicle adenocarcinoma was confirmed pathologically.The patient received pelvic radiotherapy for six weeks,and to date,no evidence of recurrence has been found.CONCLUSION Seminal vesicle cysts should be monitored long-term.Seminal vesicle adenocarcinoma presents with non-specific symptoms and can be diagnosed by immunohistochemistry.

Acute diffuse peritonitis secondary to a seminal vesicle abscess:A case report

BACKGROUND Seminal vesicle abscess(SVA)is the manifestation of a relatively rare urinary system infection.In response to urinary system inflammation,an abscess forms in special locations.However,acute diffuse peritonitis(ADP)induced by SVA is unusual.CASE SUMMARY We report a case of a left SVA in a male patient complicated with pelvic abscess,ADP,multiple organ dysfunction syndrome,infectious shock,bacteremia,and acute appendiceal extraserous suppurative inflammation as a result of a long-term indwelling urinary catheter.The patient received a course of morinidazole+cefminol antibiotics but showed no obvious relief,so the perineal SVA underwent puncture drainage and abdominal abscess drainage+appendectomy was performed.The operations were successful.After the operation,anti-infection,anti-shock,and nutritional support treatments were continued and various laboratory indicators were regularly reviewed.The patient was discharged from the hospital after recovery.This disease is a challenge for the clinician because of the unusual spreading path of the abscess.Moreover,appropriate intervention and adequate drainage of abdominal and pelvic lesions are necessary,especially when the primary focus cannot be determined.CONCLUSION The etiology of ADP varies,but acute peritonitis secondary to SVA is very rare.In this patient,the left SVA not only affected the adjacent prostate and bladder but also spread retrogradely through the vas deferens,forming a pelvic abscess in the loose tissues of the extraperitoneal fascia layer.Inflammation involving the peritoneal layer led to ascites and pus accumulation in the abdominal cavity,and appendix involvement led to extraserous suppurative inflammation.In clinical practice,surgeons need to consider the results of various laboratory tests and imaging examinations to make comprehensive judgments involving the diagnosis and treatment plan.

Rectoseminal vesicle fistula after radical surgery for rectal cancer:Four case reports and a literature review

BACKGROUND A rectoseminal vesicle fistula(RSVF)is a rare complication after anterior or low anterior proctectomy for rectal cancer mainly due to anastomotic leakage(AL).Limited literature documenting this rare complication is available.We report four such cases and review the literature to investigate the etiology,clinical manifestations,and the diagnostic and treatment methods of RSVF in order to provide greater insight into this disorder.CASE SUMMARY Four cases of RSVF were presented and summarized,and a further 12 cases selected from the literature were discussed.The main clinical symptoms in these patients were pneumaturia,fever,scrotal swelling and pain,anal pain,orchitis,diarrhea,dysuria,epididymitis and fecaluria.Imaging methods such as pelvic Xray,computed tomography(CT),sinus radiography,barium enema and other techniques confirmed the diagnosis.CT was the imaging modality of choice.In cases presenting with reduced levels of AL,minimal surrounding inflammation,and controlled infection,the RSVF was conservatively treated by urethral catheterization,antibiotics administration and parenteral nutrition.In cases of severe RSVF,incision and drainage of the abscess or fistula and urinary or fecal diversion surgery successfully resolved the fistula.CONCLUSION This study provides an extensive analysis of RSVF,and outlines,summarizes and examines the causes,clinical manifestations,diagnostic procedures and treatment options,in order to prevent misdiagnosis and treatment errors.

Solitary seminal vesicle metastasis from ileal adenocarcinoma presenting with hematospermia:A case report

BACKGROUND Although metastatic adenocarcinoma of the ileum is not uncommon,solitary metastasis to the seminal vesicle has not been reported.We report a patient with recurrent hematospermia diagnosed with metastasis to the seminal vesicle following ileal adenocarcinoma resection,his subsequent management and outcome.CASE SUMMARY A 46-year-old man presented with recurrent episodes of painless hematospermia.This was not associated with any lower urinary tract symptoms.He had a past medical history of ileal tumor at the terminal ileum with solitary mesenteric lymph node metastasis on presentation,and underwent partial ileectomy and lymphadenectomy 4 years ago.Subsequent investigations included positronemission tomography and computed tomography imaging confirmed the very unusual diagnosis of a solitary tumor at the left seminal vesicle.Laparoscopic leftsided vesiculectomy was carried out.Histological analysis with immunohistochemistry showed that CDX-2 was positive and CK7 was negative,and the appearance was consistent with the diagnosis of recurrent metastatic adenocarcinoma of his previously treated intestine primary.The patient had an uneventful post-operative recovery.He received adjuvant chemoradiotherapy following surgery.He remained asymptomatic until he developed multiple bone and pulmonary metastases one year after surgery.CONCLUSION Clinicians should be aware of hematospermia as the first symptom of metastatic recurrence in patients with a history of ileal adenocarcinoma.

A Pelvic Free-Floating “Intraperitoneal Mice” Mimicking Seminal Vesicle Malignancy: A Case Report

Peritoneal loose bodies or “peritoneal mice” are rare well circumscribed benign masses composed of free-floating organized fat necrosis. They are usually asymptomatic and found as “incidentalomas” during Imaging. Their pathogenesis is not well known. We report a rare case of giant intraperitoneal mice which was clinically misdiagnosed as left seminal vesicle malignancy. A review of the literature is also presented.

Constraint Analysis and Bladder Wall Low-Dose-Constraint Reduction in Five-Fraction Urethra-Sparing Prostate SBRT

Aim: To compare and analyze dose constraints and target coverage results and to reduce Bladder Wall (Bwall) V18.12 for prostate Stereotactic-Body Radiation Therapy (SBRT) when Seminal Vesicles (SSVV) are included or not. Several indicators based on intersection volumes are obtained to predict constraint fulfillment. Background: Due to prostate’s low alpha-beta ratio and the possibility of increasing the therapeutic ratio several moderate and extreme hypofractionation schemes have been proposed. The scheme selected was a fivefraction urethra-sparing prostate SBRT. Materials and Methods: 150 patients divided into two groups according to the inclusion of SSVV in PTV or not were analyzed. Histograms, average values, standard deviations and degrees of fulfillment were obtained for each constraint or goal and group. A possible reduction of the Bwall V18.12 was addressed by re-optimizing fifty randomly chosen patients. Predictors of constraint fulfilling were obtained by using the intersections of Bwall and Rectum Wall (Rwall) with the PTV. Results: Significant differences in Rwall V32.62 and V29 were obtained when evaluating the influence of SSVV inclusion. A reduction of 12% in the Bwall V18.12 constraint was achieved without compromising coverage and OARs doses. No dependence on the inclusion of SSVV was found. Conclusions: Statistically significant differences have been found in Rwall intermediate-dose constraint when SSVV was included. A reduction of 12% in the Bwall V18.12 constraint has been achieved without compromising the PTV coverage and the rest of OARs constraints. Constraint fulfillment predictors could be useful to evaluate the feasibility of prostate SBRT prior to the planning process for every single patient.

Zinner’s Syndrome: A Confusing Diagnosis in the Face of Chronic Disabling Perineoscrotal Pain in the Young Subject, about a Case

Zinner syndrome is a rare congenital malformation related to an abnormality in the development of the Wolffian duct, the clinical picture of which consists of a triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and obstruction of the ejaculatory duct. Chronic perineoscrotal pain may be an indication of the diagnosis of Zïnner syndrome to some extent. We report the observation of a 23-year-old patient, married and father of one child, who presented with chronic perineo-scrotal pain revealing on morphological assessment (ultrasound, uroscanner, prostatic MRI) a cystic formation of the seminal vesicle, left renal agenesis with an empty left renal compartment. Given the patient’s refusal of any surgical procedure, treatment consisted of echo-guided puncture of the seminal vesicle cyst bringing back 30 cc of a seroviscous liquid whose analysis revealed spermatozoa, without atypical cells, compatible with a cyst. The clinical evolution was marked by a progressive remission of the scrotal pain with a delay of several months.

Neoadjuvent androgen deprivation for seminal vesicle reduction:The optimal portion of seminal vesicle included in the high-dose CTV in localized prostate cancer radiotherapy

Objective:To clarify the length and volume reduction of seminal vesicles(SVs)after neo-adjuvant hormonal therapy(NHT),in order to help contour the optimal SV included into high-dose clinical target volume(CTV)for radiotherapy in intermediate-and high-risk patients.Methods:MR images both before and after NHT(5.3±2.2 months)were collected from thirty-one patients with cT2-4N0M0 prostate cancer.SV volume was measured in axial T1WI,while SV length was obtained in a reconstructed oblique coronary plane through its long axial from a 3D sequence.Results:SVs showed evident reduction both in length and volume(length:median 12.1%,range 4.0%–28.0%;volume:median 39.9%,range 9.4%–66.2%).For SVs with and without MR detected involvement,length shortening were(16.7±4.8)%and(11.1±4.4)%(P<0.001);for involved SVs and lesions,volume reduction were(41.0±16.0)%and(66.3±14.4)%,respectively(P<0.001),both indicating a more sensitive response to NHT of the involved portion than normal SV.Conclusions:Both volume and length of the SV will be reduced after receiving NHT.Besides,the invaded segments shrink more than normal SV tissue,indicating that SV portion included within the CTV can be reduced.

Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy

The purpose of this study was to analyze the value of transrectal shear-wave elastography(SWE)in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy(RP).Preoperative clinicopathological variables,multiparametric magnetic resonance imaging(mp-MRI)manifestations,and the maximum elastic value of the prostate(Emax)on SWE were retrospectively collected.The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology,and parameters with statistical significance were selected.The diagnostic performance of various models,including preoperative clinicopathological variables(model 1),preoperative clinicopathological variables+mp-MRI(model 2),and preoperative clinicopathological variables+mp-MRI+SWE(model 3),was evaluated with area under the receiver operator characteristic curve(AUC)analysis.Emax was significantly higher in prostate cancer with extracapsular extension(ECE)or seminal vesicle invasion(SVI)with both P<0.001.The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa,respectively.Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE(model 2 vs model 1,P=0.031;model 3 vs model 1,P=0.002;model 3 vs model 2,P=0.018)and SVI(model 2 vs model 1,P=0.147;model 3 vs model 1,P=0.037;model 3 vs model 2,P=0.134).SWE is valuable for identifying patients at high risk of adverse pathology.