|LETTER TO THE EDITOR
|Year : 2019 | Volume
| Issue : 8 | Page : 178-179
Primary prostatic non-Hodgkin's lymphoma presenting with features of prostatism
Pradeep Kumar, Khaliqur Rahman, Nosad Hussein, Ruchi Gupta, Soniya Nityanand
Department of Hematology, SGPGI, Lucknow, Uttar Pradesh, India
|Date of Web Publication||22-Mar-2019|
Department of Hematology, SGPGI, Lucknow - 226 014, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar P, Rahman K, Hussein N, Gupta R, Nityanand S. Primary prostatic non-Hodgkin's lymphoma presenting with features of prostatism. J Can Res Ther 2019;15, Suppl S1:178-9
|How to cite this URL:|
Kumar P, Rahman K, Hussein N, Gupta R, Nityanand S. Primary prostatic non-Hodgkin's lymphoma presenting with features of prostatism. J Can Res Ther [serial online] 2019 [cited 2021 Sep 22];15:178-9. Available from: https://www.cancerjournal.net/text.asp?2019/15/8/178/244238
Primary prostatic non-Hodgkin lymphoma (NHL) is a rare condition and is usually diagnosed on histopathological examination. The tumor accounts for 0.09% of all prostatic neoplasms and 0.1% of all NHLs. Here, we report a case of primary prostatic NHL, diagnosed as diffuse large B-cell lymphoma. The patient was treated with systemic chemotherapy (R-CHOP) and showed a good clinical response. He relapsed after 3 years as an isolated central nervous system (CNS) relapse.
A 62-year-old male presented with complaints of urgency, frequency, and poor stream for 2–3 months which gradually worsened to acute urinary retention. On examination, he did not have any pallor or icterus. No organomegaly or lymphadenopathy was noted. Perrectal examination revealed hard and nodular prostate. Laboratory investigations revealed normal hematological and renal parameters. His PSA level was 5.32 ng/ml. Ultrasonography of the abdomen revealed median lobe enlargement, weighing approximately 98 g with a size of 58 mm × 56 mm × 59 mm, having normal echotexture, without retroperitoneal lymphadenopathy.
Histopathological examination revealed infiltration of the prostatic parenchyma by medium-to-large pleomorphic cells, which on immunohistochemical examination was positive for LCA and CD20 and was negative for CK and PSA, suggesting the diagnosis of a B-cell NHL [Figure 1]. Bone marrow was not involved. Computed tomography of the abdomen and thorax did not reveal any lymphadenopathy. He was categorized as Stage I Extranodal and treated with R-CHOP-based chemotherapy. He showed a good response with no residual disease on mid-cycle or end of treatment evaluation. He was on regular follow-up with no evidence of disease till 32 months when he presented in emergency with altered sensorium and urinary retention. Investigation revealed prostatomegaly which on histopathological examination revealed a normal histology. Magnetic resonance imaging brain revealed a heterogeneously enhancing space-occupying lesion in the right basal ganglia region involving right thalamus, frontotemporal, and hypothalamus region suspicious of metastasis. Positron emission tomography revealed a metabolically active brain lesion in the right basal ganglia region only. He was lost to follow-up leading to unavailability of a confirm histopathological diagnosis.
|Figure 1: Section from the prostatic core biopsy shows infiltration of prostatic tissue by apical cells (a: H and E, ×4). These cells were hyperchromatic with high N: C ratio and nuclear atypia (b: H and E, ×40). These cells were positive for LCA (c), CD20 (d), while negative for CK (e), and PSA (f)|
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Primary prostatic NHL is a rare condition with a prevalence at autopsy being reported as 0.2%., The criteria for diagnosing primary prostatic lymphoma is predominant involvement of prostate, without any other nodal, peripheral blood, bone marrow, liver, or splenic involvement. These patients usually present with prostatic symptoms only. Systemic symptoms like fever, weight loss, and night sweating are very uncommon and seen after disease dissemination. Due to the rarity of this entity, the treatment has not been optimized. Most of the patients are treated with standard CHOP-based chemotherapy. In the retrospective review of 62 patients by Bostwick et al., there were no significant differences in survival between patients receiving different therapies. The prognosis depends mainly on patients' age, histological classification, tumor stage, and type of infiltration (primary or secondary), rather than the modality of treatment. This case is worth reporting because of the rarity as well as probable isolated CNS relapse of this case of primary prostatic NHL.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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