Case 1070 - A Man in His 30s with Hematospermia

Contributed by Swati Satturwar MD, Rajiv Dhir MD, MBA


A man in late thirties presented to the Urology clinic with complaint of hematospermia since 6 months.

MRI abdomen and pelvis: Demonstrated 1.1 cm PI-RAD 4 lesion and a midline 3.5 cm Mullerian duct cyst.

PSA level : 0.4 ng/ml (normal)

He underwent prostate biopsy and diagnosed with basal cell carcinoma of prostate. Patient underwent follow-up radical prostatectomy.

Histologic examination of the biopsy (Figure 1) showed invasive nests of basaloid cells with solid and adenoid cystic carcinoma like areas infiltrating prostatic stroma. Immunohistochemistry showed that the tumor cells were strongly and diffusely positive for basal cell markers (p63 and cytokeratin 903). In addition showed diffuse overexpression of BCL-2. Ki-67 proliferation index was increased (approximately 25%). The tumor cells were negative for NKX3.1 and GATA-3. The tumor cells were diffusely positive for cytokeratin 7 and cytokeratin 20 (focal).

Follow-up resection (Figure 2) showed similar features of invasive basal cell carcinoma of prostate with areas showing basal cell carcinoma like morphology (solid nests of tumor cells with focal peri-pheral palisading of cells and apoptotic cells at the center) and adenoid cystic carcinoma like morphology with cribriform appearance. Tumor cells were strongly and diffusely positive for immunostain p63 protein.


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