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Figure 1b

 

Figure 2

Urinary bladder and left seminal vesicle was enclosed in mass. The tumour was measured 12 x 6 x 8 cm and had distinct fat planes with the adjacent anterior wall of the rectum. The right seminal vesicle was normal and the prostate gland was displaced inferiorly (fig 3).

Figure 3 a

Figure 3b

His chest radiograph was normal. Bladder tumor was suspected. Cystoscopy and microscopic analysis of the tumor biopsy showed infiltration of liposarcoma.Laparotomy was performed, revealing a hard circumscribed mass, arising in the bladder lumen and involving the left seminal vesicle.Since histological and immunohistochemistry examination revealed that the tumour was a myxoïde liposarcoma in close relation of left seminal vesicle with bladder extension

DISCUSSION 

Primary malignancies of the seminal vesicles are rare. Most reported cases are carcinoma (1). Both carcinoma and sarcoma of the vesicle carry a poor prognosis.A review of literature revealed few cases of primary sarcomas of the seminal vesicles. But no previous report of a primary liposarcoma of the seminal vesicle. Sarcoma may originate from the connective tissue of the vesicle itself or from the adjacent retrovesical pouch structures, with early invasion of the vesicle (2). Schned et al have mentioned in their scholary review that many of the reported cases of primary sarcomas of the seminal vesicle are poorly documented. This due in part to the tendency of this tumour to widely invade neighbouring structures, often obscuring the actual place of origin. Other reasons cited by them for questioning the validity of many of the previously reported cases is the lack of histological verification (3). In our case the tumour was topographically centred in the parietal urinary bladder and in the left seminal vesicle. Chirurgical and histological results rectified diagnosis.Clinically, these tumours can yield a wide range of symptoms, depending in part on the tumour size and contiguous spread. This usually present with pelvic or perineal pain, haemospermia, urinary infection or bladder outflow obstruction (1,2,4). Ultrasonography, CT scan and magnetic resonance imaging may be helpful in localizing the tumor (1,4). A CT scan and MRI revealed a lobulated heterogeneously enhancing mass topographically centrated in the seminal vesicle. They determined extending to adjacent organs. Trans rectal ultrasonography (TRUS) guided biopsy for histologic result (1,4).In early stage of the disease these radiologic examinations can help to exclude tumours of the adjacent organs, like prostate, rectum or urinary bladder, and might also demonstrated the epicentre of tumor in advanced stage of disease. Surgery is the treatment of choice in the absence of distant metastatic spread. In cases with widespread distant metastases, chemotherapy is the preferred line of treatment.In summary, the diagnosis of seminal vesicle tumor is based on correlation of clinical, imaging, and histological finding. Differential diagnosis was meatstatic bladder urinary.FIGURE: Fig 1: sagital (a) and axial (b) MR on T2-weighted images demonstrating very extensive retrovesical and vesical mass in the area of the left seminal vesicle, on high and heterogeneous signal. The tumour was extending to urinary bladder with parietal infiltration. Fig 2: axial MR images showed the mass on low signal on T1-weighted images. Fig 3: axial T2-weighted image (a) and coronal proton-density with fat-suppressed (b) showing that right seminal vesicle was normal (arrows).

1/ Sanghvi DA, Purandare NC, Jambhekar NA, Thakur MH, Joshi MS. Primary rhabdomyosarcoma of the seminal vesicle. British J Radiol 2004; 77: 159-60.2/ Williamson RCN. Seminal vesicle tumours. J Roy Soc Med 1978; 71: 286-8.3/ Schned AR, Ledbetter JS, Selikowitz SM. Primary leiomyosarcoma of the seminal vesicle. Cancer 1986; 57: 2202-6.4/ Tarjàn M, Ottlecz I, Tot T. Primary adenocarcinoma of the seminal vesicle. Indian J Urol 2009; 6: 143-5.