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LETTER TO THE EDITOR
Year : 2019  |  Volume : 15  |  Issue : 8  |  Page : 178-179

Primary prostatic non-Hodgkin's lymphoma presenting with features of prostatism


Department of Hematology, SGPGI, Lucknow, Uttar Pradesh, India

Date of Web Publication22-Mar-2019

Correspondence Address:
Khaliqur Rahman
Department of Hematology, SGPGI, Lucknow - 226 014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_886_16

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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 2020 Nov 28];15:178-9. Available from: https://www.cancerjournal.net/text.asp?2019/15/8/178/244238



Sir,

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.[1] 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%.[2],[3] The criteria for diagnosing primary prostatic lymphoma is predominant involvement of prostate, without any other nodal, peripheral blood, bone marrow, liver, or splenic involvement.[4] 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.,[5] 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.[2] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Sarris A, Dimopoulos M, Pugh W, Cabanillas F. Primary lymphoma of prostate: Good clinical response with doxorubicin based combination chemotherapy. J Urol 1995;153:1852-4.  Back to cited text no. 1
    
2.
Indumati A, Bijal K, Borges A, Advani SH. Primary prostatic non Hodgkin's lymphom: A case report. Indian J Med Paediatr Oncol 2004;25:32-4.  Back to cited text no. 2
    
3.
Zuazu JR, Iglesias R, Costa DR, Mayans AR, Rosello XB, Santos AP, et al. Prostatic lymphoma and literature review. Actas Urol Esp 2009;33:686-90.  Back to cited text no. 3
    
4.
Eisenberger CF, Walsh PC, Eisenberger MA, Chow NH, Partin AW, Mostwin JL, et al. Incidental non-Hodgkin's lymphoma in patients with localized prostate cancer. Urology 1999;53:175-9.  Back to cited text no. 4
    
5.
Bostwick DG, Iczkowski KA, Amin MB, Discigil G, Osborne B. Malignant lymphoma involving the prostate: Report of 62 cases. Cancer 1998;83:732-8.  Back to cited text no. 5
    


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