case report
Primary signet ring cell carcinoma of the prostate treated by radical
cystoprostatectomy and chemoradiotherapy
1
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Sun Wook Kim, MD; Woohyun Kim, MD; Yong-Hyun Cho, MD, PhD; Tae-Jung Kim, MD, PhD;
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Insuk Woo, MD, PhD; Dong Wan Sohn, MD, PhD
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Department of Urology, Department of Hospital Pathology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Cite as: Can Urol Assoc J 2016;10(1-2):E204-6. http://dx.doi.org/10.5489/cuaj.3122
Published online May 12, 2016.
Case report
In July 2013, a 56-year-old Korean man was referred to
our institution for evaluation of a one-month history of
hematuria and recently identified bladder mass. The patient
had no concomitant medical problems or family history of
malignancy. The dynamic abdomen and pelvis computed
tomography (CT) scan showed an enlarged prostate (5.0 x
Abstract
Primary signet ring cell carcinoma (SRCC) of the prostate is very
rare. Although SRCC is primarily found in the stomach and colon,
it can also be found in the pancreas, breast, thyroid, bladder, and
prostate. We recently diagnosed and treated a case of primary
SRCC of the prostate.
A 56-year-old Korean man was referred to our institution for
evaluation of a one-month history of hematuria and recently identi-
fied bladder mass. Transurethral resection of the bladder tumour
was performed and histological and immunohistochemical evalua-
tion revealed a diagnosis of SRCC with tumour invading into the
outer half of the deep muscularis propria. After three weeks, the
patient had radical cystoprostatectomy with ileal conduit. Tumour
involved both prostate and bladder, but the centre of the tumour
was located in the prostate. Duodenoscopy and colon fibroscopy
both indicated no evidence of tumour origin in the gastrointestinal
5
.2 cm) with irregular, ill-defined margins protruding into
the bladder base with calcification. Physical examination,
including digital rectal exam, was unremarkable. Serum
prostate-specific antigen level was 0.64 ng/mL
Transurethral resection of the bladder tumour was per-
formed. Cystoscopy revealed multiple irregular masses in
the prostate and bladder base. Grossly, the epicentre of the
tumour was located in the prostate and histological and
immunohistochemical evaluation revealed a diagnosis of
SRCC with tumour invading into the outer half of the deep
muscularis propria.
Two weeks later, duodenoscopy and colonoscopy were
performed for evaluation of the GI tract and no evidence
of tumour was found. In addition, there were no metastatic
lesions on chest CT scan. Invasion of bilateral seminal ves-
icles was identified on bladder magnetic resonance imaging
(GI) tract. Overall, this tumour was regarded as primary SRCC of the
prostate. Concurrent chemoradiotherapy (CCRT) using leucovorin
and fluorouracil was initiated two months later. The patient eventu-
ally developed bone and liver metastases and died of hepatopathy.
(
origin, and radical cystoprostatectomy with ileal conduit
was performed.
MRI) (Fig. 1). Therefore, we diagnosed SRCC of prostate
Introduction
Primary signet ring cell carcinoma (SRCC) of the prostate is
very rare. It was first reported in 1979 and is estimated to
occur in 2.5% of cases of adenocarcinoma of the prostate.
Pathologically, the tumour cells were comprised of
loosely dispersed, neoplastic epithelial cells containing
intracytoplasmic mucin that displaced the nuclei towards
the periphery. The resulting crescent-shaped nuclei were
consistent with SRCC (Fig. 2). There was no involvement of
the ureters or the urethra; however, tumour invaded peri-
rectal fat and metastasis was found in one of nine pelvic
lymph nodes. The results of immunohistochemical stainings
implied the possibility of colorectal origin, since CDX-2 and
CK20 were positive, while CK-7, TTF-1, and AMACR were
negative (Figs. 3, 4; Table 1). Serum carcinoembryonic anti-
1
Although SRCC is primarily found in the stomach and colon,
it can also be found in the pancreas, breast, thyroid, bladder,
2
and prostate. We recently diagnosed and treated a case of
primary SRCC of the prostate.
E204
CUAJ • May-June 2016 • Volume 10, Issues 5-6
2016 Canadian Urological Association
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