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CASE SNIPPET
Year : 2019  |  Volume : 65  |  Issue : 2  |  Page : 121-122

Solitary neurofibroma of seminal vesicle


Department of Urology, MIOT International, 4/112, Mount Poonamallee Road, Manapakkam, Chennai - 600 089, Tamil Nadu, India

Date of Web Publication26-Apr-2019

Correspondence Address:
S Rajaian
Department of Urology, MIOT International, 4/112, Mount Poonamallee Road, Manapakkam, Chennai - 600 089, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_409_18

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How to cite this article:
Rajaian S, Paulraj A S, Murugesan L. Solitary neurofibroma of seminal vesicle. J Postgrad Med 2019;65:121-2

How to cite this URL:
Rajaian S, Paulraj A S, Murugesan L. Solitary neurofibroma of seminal vesicle. J Postgrad Med [serial online] 2019 [cited 2019 May 20];65:121-2. Available from: http://www.jpgmonline.com/text.asp?2019/65/2/121/254826




A 53-year-old male patient presented to our clinic with a history of urinary hesitancy, intermittency and sense of incomplete voiding for the past 1-year duration. No other symptoms like hematuria or perineal pain were noted. Rectal examination revealed an ill-defined swelling in the left side of the pelvis in continuity with the prostate. External genitalia appeared normal. No clinical stigmata of von Recklinghausen's disease were noted. Transabdominal ultrasound showed a retrovesicular swelling with solid and cystic areas. Radiological examination using computerized tomography (CT) and magnetic resonance imaging (MRI) confirmed that the lesion was arising from the left seminal vesicle [Figure 1]. Bilateral upper urinary tracts appeared normal.
Figure 1: Radiological features. (a) Axial, (b) coronal, and (c) sagittal T2W MRI images showing well-circumscribed heterogeneous hyperintense lesion with central hypointensity seen arising from the left seminal vesicle (target appearance). (d-f) Axial and coronal T1W fat-saturated MRI images showing well-defined heterogeneous hyperintense lesion in left rectovesical pouch extending posterior to pararectal space. No evidence of calcification or hemorrhage was noted

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After thorough evaluation, he underwent diagnostic cystoscopy, and left retrograde pyelography (RGP). Cystoscopy was normal. Left RGP showed medially deviated left ureter due to the mass. A ureteric catheter was placed in the left ureter for its identification intraoperatively. Laparoscopic excision of the left seminal vesicle with mass was done.

The histopathology and immunohistochemistry showed features of neurofibroma arising from the left seminal vesicle [Figure 2]. The postoperative period was uneventful, and the patient voided well after catheter removal. At 3 years of follow-up, patient was doing well.
Figure 2: Pathological features. (a) Gross examination showed well-encapsulated fleshy tan-colored tumor replacing the seminal vesicle. (b) H and E 10×; microscopically, the neoplasm was composed of elongated spindle-shaped cells along with abundant mucin, collagen bundles, and thin-walled blood vessels. (c) H and E 100×, showing spindle-shaped cells with elongated wavy nuclei. No evidence of mitosis was noted. (d-f) Immunohistochemical staining revealed that the tumor cells were positive for S-100 (40×) and vimentin (40×), and negative for CD34 (10×)

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Primary tumors of the seminal vesicles are rare; however, secondary tumors are common.[1] Most common among the primary tumors are adenocarcinomas. Benign tumors like adenoma, leiomyoma, teratoma, schwannoma (neurilemoma), and cystadenoma arising from seminal vesicle have been reported.[1] The differentiation of primary and secondary tumor is only established by histopathological analysis after excision of the mass or after biopsy.[1]

Neurofibroma is a benign overgrowth having disorganization of normal nerve tissues with the accumulation of inflammatory cells and blood vessels.

Neurofibromas of urinary system may arise from pelvic, bladder, and prostatic nerve plexus. They commonly involve urinary bladder and, at times, prostate, urethra, spermatic cord, testis, penis, and ureter.[2],[3] Solitary neurofibroma of spermatic cord has been reported earlier.[3],[4],[5] However, solitary neurofibroma of the seminal vesicle has not been reported so far.

Histologically, most neurofibromas are unencapsulated tumors and consist of elongated fibroblasts with bent, wavy, and serpentine nuclei separated by abundant fine collagen fibers and blood vessels.[6] Encapsulation of neurofibroma, as in our case, occurs in only 4% of the neurofibromas.[7] The tumor has strong immunoreactivity for vimentin and S-100.

To conclude, solitary neurofibroma of the seminal vesicle should be considered as a differential diagnosis in seminal vesicular lesions.

Declaration of patient consent

The authors certify that appropriate patient consent was obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 :: References Top

1.
Kim B, Kawashima A, Ryu JA, Takahashi N, Hartman RP, King BF Jr. Imaging of the seminal vesicle and vas deferens. Radiographics 2009;29:1105-21.  Back to cited text no. 1
    
2.
Umakanthan S, Naik R, Bukelo MM, Rai S, Prabhu L. Primary bladder neurofibroma: A rare case with clinical implications and diagnostic challenges. J Clin Diagn Res 2015;9:ED05-6.  Back to cited text no. 2
    
3.
Milathianakis KN, Karamanolakis DK, Mpogdanos IM, Trihia-Spyrou EI. Solitary neurofibroma of the spermatic cord. Urol Int 2004;72:271-4.  Back to cited text no. 3
    
4.
Boto J, Boudabbous S, Lobrinus JA, Gourmaud J, Terraz S. Solitary neurofibroma of the spermatic cord: A case report. J Radiol Case Rep 2015;9:19-28.  Back to cited text no. 4
    
5.
Deliveliotis C, Albanis S, Skolarikos A, Varkarakis J, Protogerou V, Tamvakis N, et al. Solitary neurofibroma of the spermatic cord. Int Urol Nephrol 2002;34:373-5.  Back to cited text no. 5
    
6.
Mahmud SA, Shah N, Chattaraj M, Gayen S. Solitary encapsulated neurofibroma not associated with neurofibromatosis-1 affecting tongue in a 73-year-old female. Case Rep Dent 2016;2016:3630153.  Back to cited text no. 6
    
7.
Marzola C, Borguetti MJ, Consolaro A. Neurilemmoma of the mandible. J Oral Maxillofac Surg 1988;46:330-4.  Back to cited text no. 7
    


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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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