Department of Urology, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland.
Urol Int. 2023;107(10-12):977-982. doi: 10.1159/000534088. Epub 2023 Oct 25.
Solitary fibrous tumors (SFTs) of the prostate are extremely rare. We report on a 60-year-old man who was diagnosed with prostatic SFT through transurethral resection (TUR) of the prostate, and we provide a narrative literature review to put the case into perspective. We looked into multiple databases for articles published before June 2022.
A 60-year-old man without comorbidities presented with acute urinary retention and significant macrohematuria. Due to recurrent bladder tamponades and relevant blood loss despite irrigation, an emergency endoscopic transurethral evaluation was initiated. Intraoperatively, diffuse venous hemorrhage from prostatic vessels around the bladder neck was detected, as well as significant hemorrhage from a grossly enlarged and tumor-suspicious prostate middle lobe. Within the framework of extensive bipolar coagulation, parts of the suspicious middle lobe were removed via TUR. The final histopathology report showed incompletely resected SFT of the prostate. Due to the extremely rare SFT diagnosis, the case was discussed in an interdisciplinary tumor board and further diagnostic workup, including thoracoabdominal computed tomography and magnetic resonance imaging of the pelvis, was performed, which revealed no secondary tumors or signs of metastasis. According to the tumor board recommendation, robot-assisted radical prostatectomy (RARP) with bilateral nerve sparing was performed, supported by intraoperative frozen section. The final histopathology confirmed the SFT that had developed from the transition zone. The SFT was resected with negative frozen section result and negative surgical margins (R0). No intra- and perioperative complications occurred, and in the short-term follow-up, the patient presented in excellent general status with full continence. From 1997 to June 2022, we identified a total of 12 publications reporting on treatment for prostatic SFT (11 case reports and 2 patient series), with none performing bilateral nerve sparing, frozen section, or robot-assisted radical prostatectomy. No common survival endpoints were accessible.
This case demonstrates the exceedingly rare case of SFT of the prostate, which has been described in the literature in only 23 men worldwide. Here, we were the first to demonstrate the feasibility of bilateral nerve-sparing RARP supported by frozen section. A systematic review was not possible due to the lack of common endpoints.
前列腺孤立性纤维瘤（SFT）极为罕见。我们报告了一例通过经尿道前列腺切除术（TURP）诊断为前列腺 SFT 的 60 岁男性病例，并进行了文献综述以阐明该病例。我们查阅了多个数据库，以获取截至 2022 年 6 月之前发表的文章。
一位无合并症的 60 岁男性因急性尿潴留和明显肉眼血尿就诊。由于反复膀胱填塞和冲洗相关的大量失血，紧急进行了内镜经尿道评估。术中发现膀胱颈部周围前列腺血管弥漫性静脉出血，以及中叶明显增大和疑似肿瘤的前列腺大量出血。在广泛双极电凝的框架内，通过 TUR 切除了部分可疑中叶。最终的组织病理学报告显示前列腺部分切除的 SFT 不完整。由于 SFT 的诊断极为罕见，该病例在肿瘤多学科委员会进行了讨论，并进行了进一步的诊断性检查，包括胸腹计算机断层扫描和骨盆磁共振成像，未发现继发性肿瘤或转移迹象。根据肿瘤委员会的建议，进行了机器人辅助根治性前列腺切除术（RARP），并进行了双侧神经保留，术中采用冷冻切片。最终的组织病理学证实了源自移行区的 SFT。SFT 在冷冻切片结果阴性和切缘阴性（R0）的情况下被切除。无术中及围手术期并发症，短期随访中患者整体状况良好，完全控尿。从 1997 年至 2022 年 6 月，我们共发现 12 篇文献报告了前列腺 SFT 的治疗（11 例病例报告和 2 例患者系列），均未行双侧神经保留、冷冻切片或机器人辅助根治性前列腺切除术。无法获得共同的生存终点。
本病例展示了极为罕见的前列腺 SFT 病例，全球仅有 23 例男性文献报道。在此，我们首次证明了在冷冻切片支持下双侧神经保留 RARP 的可行性。由于缺乏共同的终点，因此无法进行系统评价。
