|Year : 2002 | Volume
| Issue : 2 | Page : 171-172
Leiomyosarcoma of the prostate - a case report
G Jayant Sastri, Sambit K Mohanty, A Munshi, S Ghosal, SC Sharma, FD Patel
Department of Radiotherapy and Histopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
Sambit K Mohanty
No. 1194/50, Sector 6, Development Authority (Near Montessori High School), Cuttack, Orissa
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Leiomyosarcoma of the prostate is a rare entity. It is the most common prostate sarcoma in the elderly. We report a case of prostatic leiomyosarcomia in a 60-year-old male.
Keywords: Leiomyosarcoma; Prostate
|How to cite this article:|
Sastri G J, Mohanty SK, Munshi A, Ghosal S, Sharma S C, Patel F D. Leiomyosarcoma of the prostate - a case report. Indian J Urol 2002;18:171-2
| Introduction|| |
The malignant mesenchymal lesions of the prostate has been classified into sarcomas of specialised prostatic stroma (stromal proliferations of uncertain malignant potential and prostatic stromal sarcoma) and other sarcomas equivalent to their soft tissue counterparts. The latter group accounts for only 0.1-0.2% of all primary prostatic tumours. 
Leiomyosarcoma is the second most common sarcoma of prostate next to rhabdomyosarcoma accounting for 25% of all prostatic- sarcomas.  We report a case of prostatic leiomyosarcoma in a 60-year-old male.
| Case Report|| |
A 60-year-old male presented with history of dysuria of 4-months' duration, which was associated with lower abdominal pain and pain in left lower limb. His vitals were normal. There was no history of hypertension or diabetes. He underwent open prostatectomy in a local hospital and was referred to PGIMER, Chandigarh. On examination, a scar was noticed in the hypogastric region, which on palpation revealed a 5 cm diameter almost globular, nontender, immobile mass. Rest of the abdomino-pelvic organs were within normal limits. Digital rectal examination revealed a large hard growth anterior to the rectum with obliteration of median sulcus. Upper border of prostate could not be reached. Ultrasonography showed the presence of a mass measuring approximately 104 x 94 mm in size in the region of prostate. On transrectal ultrasound, the mass appeared predominantly echogenic in the central portion of prostate with compressed peripheral zone [Figure - 1]. An impression of benign prostatic hyperplasia was made. Serum prostate specific antigen (PSA) was 3 ng/ml (normal = 0-4 ng/ml). Subsequently an open biopsy of the prostate was performed. Biopsy showed a diffusely infiltrating spindle cell tumour arranged in interlacing fascicles. There was moderate to marked nuclear pleomorphism and high mitotic activity (13/10 high power field) ([Figure - 2] & inset).
No epithelial element was noted. Immunohistochemically the tumour cells showed positivity for desmin and smooth muscle actin, whereas staining for cytokeratin and PSA were negative. Therefore, a diagnosis of primary leiomyosarcoma of prostate was offered and patient was started on palliative external beam radiotherapy (EBRT) to pelvis 30Gy/10#/2 weeks. The patient is on regular followup for last 6 months and is doing well.
| Discussion|| |
Sarcomas of prostate are rare tumours and can be classified as rhabdomysarcomas, leiomyosarcomas, fibrosarcomas, angiosarcomas, and others.  Prostatic leiomyosarcoma occur predominantly in the 5 th to 8 th decade and our patient is 60 years old. These tumours typically present as large infiltrative masses similar to soft tissue counterparts.  Microscopically the histomorphology is similar to soft tissue and uterine leiomyosarcoma and immunohistochemical positivity for SMA clinches the diagnosis 3 Sarcomatoid carcinoma comes as a differential diagnosis of this entity. Cytokeratin immunostaining is of value to demonstrate an epithelial component; however, it should be kept in mind that co-expression of intermediate filaments may be found in high grade sarcomas.
The reported 5-year survival of prostatic leiomyosarcoma has been 50-60%. However the prognosis of leiomyosarcoma is encouraging with aggressive combination treatment involving radical surgery and radiation therapy in selective patients. The index case depicts the classic histomorphology and immunohistochemical profile of prostatic leiomyosarcoma.
| References|| |
|1.||Siebe DB (ed.). Te Slaa : Adult man with a rhabdomyosarcoma of the prostate. Scand J Urol Nephrol 1991; 25: 329-330. |
|2.||Mottola A, Selli C, Carini M, Natali A, Gambacorta G. Leiomyosarcoma of the prostate. Eur Urol 1985; 11: 131-133. |
|3.||Cambronero SJ, Martin MM, Villacampa AF et al. Prostate leiomyosarcoma with perinea) exophytic mass. Acta Urol Esp 1999; 23: 797-800. |
[Figure - 1], [Figure - 2]