A 56-year-old man presented with a 29 day history of urgency and twice-hourly micturition. Physical examination was shown a cystic mass in the lower left abdomen. Intravenous urography showed right kidney hydronephrosis and hydroureter. CT scan of the pelvis showed a cystic mass behind the bladder, measuring 14·6 × 10·6 × 12·0 cm . Three-dimensional reconstruction of the pelvis showed a seminal vesicle adenocarcinoma (and the extruded and displaced bladder).

Prostate specifc antigen (PSA) before admission was 40·75 ng/mL. On admission, he was clinically stable, with serum PSA concentration of 28 ng/mL. Urine cytology examination measured three times was negative. Our presumptive diagnosis based on imaging results was a seminal vesicle diverticulum. No bladder tumours were found on cystoscopy and our patient had bilateral ureteral intubation and laparoscopic resection of the pelvic mass. Histopathological examination showed seminal vesicle papillary adenocarcinoma. Immunohistochemical staining was positive for CEA and CK7, negative for CA125, PSA and PsAP. Postoperative histologic examination confirmed the diagnosis of primary papillary adenocarcinoma of the seminal vesicle.

Source: Lancet