PHYLLODES TUMOR OF THE PROSTATE: A RARE CONDITION REQUIRING CAREFUL SURVEILLANCE

An 80-year-old man presented with a single episode of frank painless hematuria without other significant lower urinary tract symptoms. Digital rectal examination revealed a benign feeling prostate. Prostate specific antigen was 1 ng/ml, and x-ray of the kidneys, ureters and bladder was normal, as was renal ultrasound. Flexible cystoscopy demonstrated a polypoid lesion at the bladder neck, which was subsequently resected. Pathological examination showed a polyp with a complex glandular architecture and a prominent stromal component. The stromal cells had a prominent eosinophilic cytoplasm and uniform round nuclei without mitosis. Review elsewhere suggested a phyllodes tumor, which had been one of the differential diagnoses (fig. 1). At subsequent resection 2 months later it was apparent that the polypoid lesion had recurred locally (fig. 2). The original tumor and the secondary tumor were sent to the Armed Forces Institute of Pathology in Washington, D. C., where they were confirmed as phyllodes tumors of the prostate, staining positively for desmin (a smooth muscle marker) and CD34 (a mesenchymal marker). Additional staging investigations included transrectal ultrasound, which revealed further regrowth of the polyp but no other suspicious lesions in the prostate gland. The polyp was resected, and sextant biopsies of the peripheral zone demonstrated normal prostatic tissue. Magnetic resonance imaging showed no evidence of local extension.