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Case report

  1. Top of page
  2. Case report
  3. Comment
  4. Acknowledgements
  5. References

A 54-year-old man presented with acute retention of urine; a DRE revealed a bony, hard, nodular mass in the left lobe of the prostate. His serum PSA level was 1.1 ng/mL. CT (Fig. 1) revealed a heterogeneous mass with calcification in the left lobe of the prostate. Needle biopsy yielded no tissue and the patient underwent TURP. The resected chips resembled cartilaginous tissue and the histology was suggestive of a low-grade chondrosarcoma. An extensive radiological and nuclear medicine evaluation revealed no primary focus elsewhere. The patient underwent radical prostatectomy in October 1997. At surgery, the prostate was free from the pubis and lateral pelvic walls, thereby excluding the possibility of extension of the chondrosarcoma from these sites into the prostate. The specimen weighed 140 g and a cartilaginous tumour (6.5×4.0×3.5 cm) was identified in the left lobe (Fig. 2). The tumour was moderately cellular, with chondrocytes showing mild nuclear pleomorphism, including binucleate and multinucleate forms, and >1 chondrocyte per lacunar space (Fig 3a,b). The matrix showed focal calcification and myxoid change. Extensive sampling revealed no foci of adenocarcinoma or chondroid metaplasia in the rest of the gland. The patient had an uneventful postoperative course and there was no evidence of recurrence at 6 months.

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Figure 1. Contrast-enhanced CT scan showing a lesion with mixed attenuation values in the left lobe of the prostate.

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Figure 2. Radical prostatectomy specimen showing a cartilaginous tumour in the left lobe of the prostate (thick arrow).

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Figure 3. Photomicrographs showing a, a low-grade chondrosarcoma (thick arrow) adjacent to normal prostatic stroma (thin arrow) ×40 and b, more than one chondrocyte per lacunar space (thin arrow) and binucleate forms (arrowheads) ×200.

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Comment

  1. Top of page
  2. Case report
  3. Comment
  4. Acknowledgements
  5. References

Sarcomas account for nearly 0.1% of all prostatic malignancies [1]. Most sarcomas are rhabdomyosarcoma in children and leiomyosarcoma in adults [1]. Other prostatic sarcomas reported include neurofibrosarcoma, malignant fibrous histiocytoma, malignant mesenchymoma and fibrosarcoma [2]. Cartilaginous metaplasia is known to occur in the prostate and Sloan and Rapoport [3] reported a case of prostatic chondroma probably arising from such metaplasia. Brendler (cited in [3]) described a chondrosarcoma of the pubis, which extended up to but never invaded the prostate. Carcinosarcomas are known to occur in the prostate [1,4] and often contain chondrosarcoma as part of their mesenchymal component. The present case is of interest as it represents the first reported of a primary chondrosarcoma of the prostate, not associated with an epithelial malignancy. The aetiology can only be conjectural; the lesion probably arose from a focus of chondroid metaplasia in the prostate. As the disease was low-grade and organ-confined, radical prostatectomy was performed with curative intent.

Acknowledgements

  1. Top of page
  2. Case report
  3. Comment
  4. Acknowledgements
  5. References

We thank Dr K. Krishnan Unni of the Department of Pathology at the Mayo Clinic, Rochester, Minnesota, USA for helping to confirm the histological diagnosis.

References

  1. Top of page
  2. Case report
  3. Comment
  4. Acknowledgements
  5. References