Ectopic prostatic tissue and seminal vesicle at pericolic fat is extremely rare. The nodules in the pericolic fat could raise a dilemma of metastatic deposits in cases of rectal adenocarcinoma. A 61 years old male underwent abdomino-perineal resection for rectal carcinoma. Nodules along with lymph nodes from pericolic fat were sampled to assess the spread. Histopathological and immunohistochemical staining of one nodule confirmed it to be the prostatic tissue while another nodule to be seminal vesicle. Seminal vesicle and prostatic heterotopia is significant in several respects, either symptomatic or asymptomatic, as the ectopic tissue can be endoscopically and histologically confused with malignancy of urinary or lower gastrointestinal system and may reflect divergent differentiation or a malformative process

Gajbi, N

Kshirsagar, A

Kumbhar, S

Wader, J

Jyotsna Wader

Ashok Kshirsagar

Neha Gajbi

Sujata Kumbhar

Directory of Open Access Journals

Ectopic Prostatic and Seminal Vesicle Tissue Confusing as Metastatic Adenocarcinoma.

CogPrints Cognitive Sciences Eprint Archive

Ectopic Prostatic and Seminal Vesicle Tissue Confusing as Metastatic Adenocarcinoma

Cognitive Sciences ePrint Archive

1 
 
  
 
 
Case Report: 
Ectopic Prostatic and Seminal Vesicle Tissue Confusing as Metastatic Adenocarcinoma. 
 
Authors 
Jyotsna Wader, Ashok Kshirsagar, Neha Gajbi, Sujata Kumbhar,  
Department of Pathology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India. 
 
Address for Correspondence 
Dr. Neha Gajbi, 
Department of Pathology, 
Krishna Institute of Medical Sciences, 
Karad, Maharashtra, India.  
E-mail: dr.komalgajbi@gmail.com 
 
Citation 
Wader J, Kshirsagar A, Gajbi N, Kumbhar S. Ectopic Prostatic and Seminal Vesicle Tissue Confusing as Metastatic 
Adenocarcinoma. Online J Health Allied Scs. 2013;12(1):8. Available at URL: http://www.ojhas.org/issue45/2013-1-8.html 
 
Open Access Archives 
http://cogprints.org/view/subjects/OJHAS.html 
http://openmed.nic.in/view/subjects/ojhas.html 
Submitted: Feb 16, 2013; Accepted: Apr 2, 2013; Published: Apr 15, 2013 
Abstract: Ectopic prostatic tissue and seminal vesicle at 
pericolic fat is extremely rare. The nodules in the pericolic fat 
could raise a dilemma of metastatic deposits in cases of rectal 
adenocarcinoma. A 61 years old male underwent abdomino-
perineal resection for rectal carcinoma. Nodules along with 
lymph nodes from pericolic fat were sampled to assess the 
spread. Histopathological and immunohistochemical staining 
of one nodule confirmed it to be the prostatic tissue while 
another nodule to be seminal vesicle. Seminal vesicle and 
prostatic heterotopia is significant in several respects, either 
symptomatic or asymptomatic, as the ectopic tissue can be 
endoscopically and histologically confused with malignancy 
of urinary or lower gastrointestinal system and may reflect 
divergent differentiation or a malformative process. 
Key Words: Ectopic prostate; Seminal vesicle; 
Adenocarcinoma 
 
Introduction: 
Ectopic seminal vesicle and prostatic tissue is an extremely 
rare finding.1,2 
We report a case of ectopic prostatic tissue showing benign 
prostatic hyperplasia and seminal vesicle in pericolic fat in a 
61 years old male operated for rectal carcinoma. 
 
Case Report 
A 61 years old male presented with constipation and pain in 
abdomen to his physician. A digital rectal examination 
revealed a firm, irregular growth. An ultra sonogram showed 
evidence of annual distal rectal growth with no signs of large 
bowel obstruction. Diagnosis of well differentiated 
adenocarcinoma was made on rectal biopsy and underwent 
abdominoperineal resection (APR) for rectal carcinoma. No 
pelvic lymphadenopathy was appreciated, and other pelvic 
organs were unremarkable. 
On gross examination, the specimen revealed an 
ulceroinfiltrative growth measuring 3 x 2 cm and involving 
80% of the circumference. Cut section of the growth revealed 
gray white tumor infiltrating the entire thickness of the 
rectum. Five nodules were dissected out from the pericolic 
fat. The largest measuring 2.3x1.5x1 cm , cut section is gray 
white in appearance. 
Microscopically, sections from the rectal growth revealed 
well differentiated adenocarcinoma – Duke’s stage IIA. 
The largest nodule from pericolic fat revealed benign glands 
embedded in a fibromuscular stroma. The glands have double 
layered epithelium comprised of an inner columnar and an 
outer basal cell layer and shows papillary infoldings – 
features suggestive of benign prostatic hyperplasia. 
The prostatic origin of the tissue was confirmed by 
immunoperoxidase staining, the glands exhibited strong 
positivity for prostate specific antigen (PSA) and 
fibromuscular stroma was positive for smooth muscle actin 
(SMA). Stains for high molecular weight cytokeratin 
(34ßE12) confirmed the basal layer of epithelium excluding 
prostatic adenocarcinoma or prostatic intraepithelial 
neoplasia. 
A small nodule was diagnosed histologically to be seminal 
vesicle with thick muscular wall and highly complex mucosal 
folds. The epithelial cells revealed large amount of 
lipofuschin pigment characteristic of seminal vesicle. 
The remaining nodules revealed lymph nodes with no 
evidence of tumor metastasis. 
Special attention was paid to find out similarity or 
dissimilarity between the primary rectal adenocarcinoma and 
the glandular tissue in the nodule. 
 
This work is licensed under a 
Creative Commons Attribution- 
No Derivative Works 2.5 India License 
Online Journal of Health and Allied Sciences 
Peer Reviewed, Open Access, Free Online Journal 
Published Quarterly :  Mangalore, South India : ISSN 0972-5997 
Volume 12, Issue 1; Jan-Mar 2013 
2 
 
 
Figure 1: Gross photograph of rectal growth – 
adenocarcinoma 
 
Figure 2 (a) and (b): Gross photograph of nodules in 
pericolic fat 
 
 
Figure 3: Ectopic seminal vesicle (H & E stain 400x) 
 
Figure 4: Ectopic prostatic tissue (H & E stain 400x) 
 
Discussion 
Ectopic prostatic tissue and seminal vesicle within pericolic 
fat is extremely rare. 
Ectopic prostatic tissue has been reported at various sites 
within and outside the genitourinary system. In most of the 
cases it was observed in testis, seminal vesicle, epididymis, 
urinary bladder, uterine cervix and vagina.3 Very few cases 
involving retrovesical space, spleen and anal canal have been 
reported. 
To the best of our knowledge, only a single case of ectopic 
seminal vesicle in scrotum has been reported in English 
literature.2 
Our case is unique in that ectopia involved both prostatic 
tissue and seminal vesicle, observed in pericolic fat in a 
patient of rectal carcinoma creating a dilemma of metastasis. 
Though some cases presented with symptoms such as 
hematuria, rectal bleeding, urethral obstruction etc., majority 
of ectopic tissue reported was an incidental finding as in our 
case. Histologically few cases revealed features of 
hyperplasia as seen in the present case. 
The definite etiology of ectopic tissue is still not clearly 
known. Numerous different theories have been proposed 
such as faulty embryogenesis, migration or misplacement of 
normal tissue, persistence of embryonic remnants, 
metaplastic change caused by chronic inflammation4 and 
seeding of viable tissue to the rectum during surgery or 
biopsy.5 
As most ectopic tissues are benign, endoresection has proven 
to be effective.6 In theory, ectopic tissue can undergo 
malignant transformation. The ectopic tissue in our case was 
benign. Even though the incidences of malignancy and 
recurrences are low follow up with endoscopic examinations 
are necessary.6 
In summary, although clearly a rare occurrence, it is 
significant to note that seminal vesicle and prostatic ectopia 
can arise within the pericolic fat of rectum and may reflect 
divergent differentiation or a malformative process.4 
Though less likely to turn to malignancy and difficult to 
interpret as given their rarity but may create a vexing clinical 
problem if not identified as being ectopic origin.1 
Seminal vesicle and prostatic heterotopia is significant in 
several respects, either symptomatic or asymptomatic, 
ectopic tissue can be endoscopically and histologically 
confused with malignancy in urinary or lower gastrointestinal 
system. 
Proper identification of the ectopic tissue and not mistaking it 
for metastatic disease is important for accurate staging of 
rectal carcinoma. 
 
 
 
 
3 
 
References: 
1. Fulton RS et al. Ectopic prostate, case report of a 
presacral mass presenting with obstructive 
symptoms. Arch Pathol Lab Med. 2001;125:286-288. 
2. Patino GE, L’Esperance JO, Stroup SP, Snitchler AN, 
Auge BK. Ectopic Seminal Vesicle presenting as 
scrotal mass. British Journal of Urology International. 
Available at 
http://www.bjui.co.uk/ContentFullItem.aspx?id=244&S
ectionType=4 
3. Rosai J. Rosai and Ackerman’s Surgical Pathology, 10th 
edition. Mosby. 2011.  pp. 1287-1288. 
4. Fu-Qing Tan et al. An unusual case of retrovesical 
ectopic prostatic tissue accompanied by primary 
prostate cancer. World Journal of Surgical Oncology. 
2012;10:186. 
5. Xin-lin WU et al. Prostatic tissue ectopia in the 
rectum. Chin Med J. 2010;123(22):3372-3374. 
6. Hung-Jen Shin et al. An unusual cause of distal ureteral 
obstruction. Ectopic prostatic tissue. JTUA. 2005;16:85-
87. 


http://doaj.org/search?source=%7B%22query%22%3A%7B%22bool%22%3A%7B%22must%22%3A%5B%7B%22term%22%3A%7B%22id%22%3A%220d7b5d35f3444c66b64667960a57eb05%22%7D%7D%5D%7D%7D%7D

Ectopic Prostatic and Seminal Vesicle Tissue Confusing as Metastatic Adenocarcinoma

Abstract

Similar works

Full text

Available Versions

Directory of Open Access Journals

CogPrints Cognitive Sciences Eprint Archive

Cognitive Sciences ePrint Archive