Giant multilocular prostatic cystadenoma is a rare, benign neoplasm that originates in the prostate gland, as shown in [1
]. The clinical presentation in all patients is similar to benign prostatic hyperplasia and includes obstructive voiding symptoms and acute urinary retention with or without a palpable abdominal mass [1
]. In the literature, patients' ages vary, ranging from 28 to 80 years old () [1
]. Enlargement of the prostate is typically seen by digital rectal examination. Before the development of imaging techniques, patients with these clinical symptoms could be falsely diagnosed as having giant benign prostatic hyperplasia. Computed tomography (CT) and in particular MRI can provide information on a large multicystic process originating from the prostate, but a clear origin cannot always be determined. It is difficult to diagnose, despite extensive radiological assessment (transabdominal and transrectal ultrasound, CT, and MRI of the pelvis). However, imaging studies are useful for determining the extent and invasiveness of the lesion.
Comparison of clinical findings, mass volume, PSA level, treatment, and follow-up between 1990 and the present case (2011)
Differential diagnosis for cystic lesions of the prostate or surrounding structures includes simple prostatic cyst, phyllodes variant of a typical prostatic hyperplasia, sarcoma of the prostate, prostatic leiomyoma, echinococcal cysts of the prostate, müllerian duct cysts, cystic dilatation of the utricle, diverticulum of the ejaculatory duct or ampulla of the vas deferens, seminal vesicle cysts, pelvic mesothelioma, multilocular peritoneal inclusion cyst, teratoma, lymphangioma, and prostatic cystic carcinoma [7
]. Prostatic cystadenomas do not invade adjacent organs; they produce a mass effect on them. Rusch et al. [8
] reported that radiographic evidence of invasion of the adjacent structures primarily excludes the possibility of a giant multilocular prostatic cystadenoma. PSA staining can disclose the prostatic origin of this lesion [5
]. Only by histology is a clear and definitive diagnosis possible. Giant multilocular prostatic cystadenoma is characterized by typical prostate gland cysts lined with double layers of columnar and cuboid cells with basally located nuclei and pale cytoplasm and epithelial cells, positive PSA staining, and no signs of malignancy [1
]. In contrast, the cells lining the cystadenocarcinoma show nuclear stratification, papillary proliferations, and roman arch structures. The growth pattern of the cystadenocarcinoma is invasive, with destruction of prostatic parenchyma and aggressive invasion into the periprostatic adipose tissue. Allen et al. [9
] fırst described high-grade prostatic intraepithelial neoplasia within a multilocular prostatic cystadenoma.
Treatment for giant multilocular prostatic cystadenoma is complete surgical excision, which provides a pathological diagnosis as well as a cure. Despite their benign nature, if these tumors are partially excised, they can regenerate and the same symptoms can recur. Recurrences have been treated by surgery, such as mass excision [8
] and pelvic exenteration [2
]; more recently, treatment with the gonadotropin-releasing hormone agonist (leuprolide acetate) [10
] has been performed. We did not consider prostatectomy as a treatment option for our patient both because he was too young (not married and no children) and we confirmed the benign nature of the mass before surgery. In addition, we did not think to delay the surgery because he had very severe obstructive voiding and defecation symptoms. In conclusion, when a retrovesical, huge cystic lesion fills the pelvis completely in young men, with high levels of serum PSA, giant multilocular prostatic cystadenoma should be considered as a differential diagnosis.