PMC4719893_01
Abdominal and pelvic CT and vasography, which were performed 19 years before diagnosis of the pelvic mass, shows left renal agenesis (A), seminal vesicle cyst (B), and ejaculatory duct obstruction (C), respectively. T2-weighted magnetic resonance image shows a large pelvic mass adjacent to the bladder (D), and seminal vesicle cyst (E). Arrowheads: seminal vesicle cyst; small arrow: vas deferens; large arrows: large pelvic mass.
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The patient had been diagnosed with Zinner syndrome, presenting with left renal agenesis (Fig. 1A), seminal vesicle cyst (Fig. 1B) and ejaculatory duct obstruction (Fig. 1C), at the age of 45. Computed tomography and magnetic resonance imaging revealed a huge mass, measuring 54 x 58 x 67 mm, which occupied the pelvic cavity (Fig. 1D and E).
Microscopic findings of biopsy (A-C) and resected sample (D and E). Histopathological examination revealed CK7-positive (A) and CK20- (B) and PSA-negative (C) non-ciliated cuboidal cells, with cytoplasm ranging from clear to eosinophilic (D), suggestive of clear cell carcinoma. The coexistence of clear cell carcinoma (black arrowheads) and normal prostate-like tissue (white arrowheads) without a defined border between them is identified in only a very small region (E). (D and E): Hematoxylin-eosin stain, x100.
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Histopathological examination revealed CK7-positive and CK20- and PSA-negative non-ciliated cuboidal cells, with the cytoplasm ranging from clear to eosinophilic, suggestive of CCC (Fig. 2A-C). Microscopic findings exhibited morphological and immunohisotchemical characteristics similar to those of CCC of the kidney (Fig. 2D and E). Normal prostatic tissue was almost replaced by CCC, but the coexistence of CCC and normal prostate-like tissue without a defined border between them was identified in only a very small region (Fig. 2E).
Microarray cluster analysis demonstrates that the gene expression pattern of the sample in this patient belonged to that of renal cell carcinoma, but not that of urothelial cell carcinoma or prostate adenocarcinoma.
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In order to decide on a course of treatment, we performed microarray cluster analysis using the sample of the present case, and compared the gene expression profiling with prostate adenocarcinoma (prostate cancer: PCa), urothelial cell carcinoma (UCC) and RCC samples, which were previously obtained during surgeries for them in our department (Fig. 3).