A 38-year-old man with hepatitis B as the only personal history of interest presented with a clinical picture of pollakiuria and vesical tenesmus of 11 months duration accompanied by terminal hematuria without clots.
On physical examination the abdomen was blade and depressible without visceromegaly or other abnormalities.
At rectal examination, the prostate had a volume I/IV, was elastic, poorly defined and almost flat.
Normal genitals.
Blood analysis with blood count, biochemistry, coagulation and PSA within normal parameters.
Urine analysis with pH 5.5.
Urinary sediment with 15-20 leukocytes/field and abundant mucus.
Sterile urocultive.
Urine cytology was negative for malignant tumor cells and in renal, bladder and prostate ultrasound no alterations were found, being the prostate homogeneous, with well defined contours, 17 x 20 mm.
Intravenous urography showed normal kidneys and ureters, and bladder displacement to the left and above by a subvesical pelvic mass (without appreciable bladder filling defects).
Cystourethrography showed bladder compression.
1.
No endovesical alterations were observed in the cystoscopy performed.
The abdominal-pelvic CT scan showed a large pelvic mass anterior to the bladder, measuring 12 cm in diameter, with well-defined contours, displacing the bladder backward and left intestinal loops.
After contrast administration, the mass increased its density.
1.
Since its origin was unclear, MRI was performed confirming that its measurements were 8x12x13cm, well-defined, located in front of the bladder and rejecting them back and left.
The mass formed lobules and was delimited by a capsule.
The diagnostic suspicion in MRI was fibroadenoma of the urachus due to its lobulated appearance and presence of fibrous tissue with nodular areas that enhanced with intravenous contrast injection.
1.
The diagnosis of FNA was 'morphological tumor, probably adenomatoid'.
The findings described above led to the excision of the tumor.
At the bimanual tact, the mass was mobilized to prostatic compression.
Through an infraumbilical midline incision and extraperitoneal access, a pelvic mass was identified located on the right side of the bladder and seemed to depend on the anterior prostatic face.
After opening the fascia endopelvian section, the mass depended on the purpose of the project.
Intraoperative biopsy was reported as a malignant epithelial tumor with intense reactive fibrosis.
Prostatectomy was not performed waiting for a definitive diagnosis, since macroscopically it seemed benign.
1.
The histopathological study described a nodular tumor measuring 12.5x12.5x7 cm, weighing 50 g, macroscopically.
In one of its edges there was 0.7 mm thick thinner.
Microscopically it was composed of a proliferation of spindle cells without atypia in variable quantity, adopting in some areas a hemangiopericytoid pattern, associated with a great differentiation of thick bundles that predominate
There were very isolated foci of malignant cells with <4 mitosis/10 high-power fields.
The venous and arterial structures were surrounded by connective tissue in which nodes with fibric differentiation were identified.
Immunohistochemical study showed positivity for CD34, D99 and vimentin, focally positive antidesmin and broad-spectrum keratins, cytokeratin 7, EMA, actin-100, enolase, S.
The tumor proliferation index expressed by Ki67 was less than 1%.
The definitive diagnosis was solitary fibrous tumor.
After three years of follow-up the patient has no recurrence of the disease in the MRI and is asymptomatic.
