Alberto, Lapini

Andrea, Chindemi

Andrea, Cocci

Campi, Riccardo

Carini, Marco

Lanciotti, Michele

Mari, Andrea

Minervini, Andrea

Riccardo, Fantechi

Serni, Sergio

Siena, Giampaolo

Tommaso, Jaeger

Tuccio, Agostino

Vittori, Gianni

English

Florence Research

order to preserve continence and potency. The specimen wasthen removed intact through the camera port by using aretrieval bag. Accurate hemostatic control was achieved and atube drain was positioned. Console time and estimated bloodloss were, respectively, 120 minutes and 50 cc; nointraoperative complications were recorded. The post-operative course was uneventful and the patient wasdischarged on the fourth postoperative day with normal bloodtests and spontaneous voiding. A two-year follow-up showedno evidence of disease recurrence. At present, the patient isfree of symptoms with full preservation of continence andpotency. Histopathological examination revealed a7.0×4.5×4.5 cm cystic SV cystoadenoma (Figure 2). No significant cytologic atypia, mitotic activity or necrosiswere present. The proliferation index was <1%. Review ofthe Literature: A systematic review of the English-languageliterature was performed using the Medline, Embase andWeb of Science databases up to December 2014. Twentycase reports have been published in literature on SVcystoadenoma (Table I). Median patient age and median tumor diameter were 49years (inter-quartile range (IQR)=42-51) and 7.0 cm (IQR5.0-12.0), respectively. No perioperative complications werereported in all the published series. Local recurrenceoccurred in 2 cases (10%) after 2 and 3 years, respectively.The differential use of diagnostic investigations and surgicalapproaches for SV cystoadenoma in the published series isshown in Figure 3. Discussion and Conclusion: Primarytumors of SVs are very rare and the differential diagnosismust be based on a multimodality approach. Most cases ofSV cystoadenoma were managed with open surgery throughtransvesicle/retrovesicle approaches or radical cysto-prostato-vesiculectomy. To date, minimally-invasive seminalvesiculectomy (MISV) is increasingly used for the treatmentof beginning diseases of SVs achieving optimal oncologicand functional results. Therefore, they could be consideredthe new gold standard for the treatment of such rare diseases.116CURRENT STRATEGIES FOR DIAGNOSIS AND TREATMENT OF BENIGN TUMORS OF SEMINAL VESICLES: A SYSTEMATIC REVIEW OF THE LITERATURERiccardo Campi, Agostino Tuccio, Giampaolo Siena,Andrea Mari, Gianni Vittori, Michele Lanciotti, Andrea Cocci, Riccardo Fantechi, Andrea Chindemi,Tommaso Jaeger, Sergio Serni, Marco Carini, Alberto Lapini and Andrea MinerviniDepartment of Urology, Careggi Hospital, University ofFlorence, Florence, ItalyIntroduction/Aim: Benign tumors (BT) of seminal vesicles (SV)are very rare. Diagnosis could be challenging and often requiresthe histopathological analysis after surgical excision. The bestsurgical treatment is still matter of discussion. The aim of thisreview is to analyze the current strategies for diagnosis andtreatment of such tumors. Materials and Methods: A systematicreview of English literature was performed using the Medline,Embase and Web of Science databases up to October 2014. Useof diagnostic investigations, options of surgical management,perioperative complications rate and oncologic outcomes wereanalyzed for each tumor histotype. Results: Fifty-eight casereports have been published in literature on BTs of SVs (Table I).Of these, 5 were excluded from the analysis due to lack of data.Cystoadenoma was found in 20 cases (38%), leiomyoma in 10(19%), schwannoma in 8 (15%), mixed epithelial-stromal tumorin 5 (9%), phyllodes tumor in 4 (8%) and other BTs in 6 (11%)(Figure 1). Median patient age and median tumor diameter were50 years (range=23-79) and 5.0 cm (range=2.0-29.0),Abstracts of the 25th Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 21-23 June, 2015, Rome, Italy3687Figure 1. (Abstract 116).ANTICANCER RESEARCH 35: 3615-3740 (2015)3688Table I. Overview of the 53 published series on benign tumors of seminal vesicles included in the analysis.Histopathological Number of Patients’ age Tumor size Number of studies with Number of studies with definition studies (years), (greatest a precise definition a precise definition (according to n (%) median (range) diameter) (cm), of the diagnostic of the therapeuticthe study) median (range) strategy n (%) strategy n (%)Cystoadenoma 20 (38) 49 (23-64) 7.0 (3.0-17.2) 10 (50) 19 (95)Mixed epithelial - stromal tumors (MEST) - low grade 5 (9) 61 (37-70) 6.5 (2.5-29.0) 4 (80) 5 (100)Leiomyoma 10 (19) 61 (37-74) 5.0 (2.0-14.5) 7 (70) 9 (90)Phyllodes Tumor 4 (8) 43 (39-59) 7.6 (5.5-14.5) 3 (75) 4 (100)Schwannoma (Neurilemmoma) 8 (15) 45 (31-79) 3.0 (2.2-7.0) 5 (63) 8 (100)Others (mammary-type 6 (11) 55 (29-79) 5.8 (2.0-14.0) 5 (83) 6 (100)myofibroblastoma, paraganglioma, cystomyoma, low-grade adnexal tumour of Wollfian origin, solitary fibrous tumor)All tumors 53 (100) 50 (23-79) 5.5 (2. 0-29.0) 34 (64) 51 (96)Figure 2. (Abstract 116).Abstracts of the 25th Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 21-23 June, 2015, Rome, Italy3689Figure 3. (Abstract 116).Table II. Use of diagnostic investigations in the published literature on benign tumors of seminal vesicles. Histopathological Ultrasound CT MRI Tumor  Intraoperative Explorative Other strategies Autopsy Definition (according (TRUS +/-  n (%) n (%) biopsy biopsies laparotomy (Cystoscopy, n (%)to the study) Abd US), n (%) n (%) n (%) FNA - Cystology, n (%) IV Urography, etc.), n (%)Cistoadenoma 6 (60) 6 (60) 7 (70) 4 (40) 1 (10) 1 (10) 2 (20) 1 (10)Mixed ephitelial - stromal tumors (MEST) low-grade 1 (25) 4 (100) 2 (50) 3 (75) 0 (0) 1 (25) 1 (25) 0 (0)Leiomyoma 3 (43) 4 (57) 4 (57) 2 (29) 0(0) 1 (15) 0 (0) 1 (15)Phylloides tumors 2 (67) 2 (67) 2 (67) 1 (33) 0 (0) 1 (33) 0 (0) 0 (0)Schwannoma (neurilemmoma) 5 (100) 4 (80) 3 (60) 4 (80) 0 (0) 0 (0) 0 (0) 0 (0)Others (mammary- 2 (40) 3 (60) 2 (40) 3 (60) 0 (0) 1 (20) 0 (0) 0 (0)type myofibroblastoma, paraganglioma, cystomyoma, low-grade adnexal tumour of Wolffian origin, solitary fibrous tumor)All tumors 19 (56) 23 (68) 20 (59) 17 (50) 1 (3) 5 (15) 3 (9) 2 (6)Numbers and percentages are referred to those studies where a precise definition of the diagnostic work-up was clearly stated (see Table I).TRUS, transrectal ultrasound; CT, computed tomography; MRI, magnetic resonance imaging; CYS, cystoscopy; FNA, fine needle aspiration;Abd US, abdominal ultrasound.ANTICANCER RESEARCH 35: 3615-3740 (2015)3690Figure 4. (Abstract 116).Table III. Use of different surgical treatments in the published literature on benign tumors of seminal vesicles. Numbers and percentages arereferred to those studies where a precise definition of the surgical technique was clearly stated (see Table I).Histopathological Open - Open - Cysto- Laparoscopic Robot- Perioperative Local definition Conservative prostato- vesiculectomy assisted complications recurrence (according tumorectomy vesiculectomy (LV) laparoscopic (Y=any n (%)to the study) (with different n (%) n (%) vesiculectomy complication approaches) (RALV) n (%) reported; n (%) N=no compli-cations reported)Cistoadenoma 11 (58) 1 (5) 5 (26) 2 (11) N 2 (10)Mixed ephitelial - stromal tumors (MEST) low grade 2 (40) 2 (40) 1 (20) 0 (0) N 0 (0)Leiomyoma 5 (55) 1 (11) 3 (33) 0 (0) N 0 (0)Phylloides tumors 2 (50) 0 (0) 2 (50) 0 (0) N 0 (0)Schwannoma 2 (25) 1 (13) 5 (63) 0 (0) N 0 (0)(neurilemmoma)Others (mammary-type 4 (67) 1 (17) 1 (17) 0 (0) N 1 (17)myofibroblastoma, paraganglioma, cystomyoma, low-grade adnexal tumour of Wolffian origin, solitary fibrous tumor)All tumors 26 (51) 6 (12) 17 (33) 2 (4) N 3 (6)respectively. In 34 papers (64%), the diagnostic work-up wasaccurately described (Table II, Figure 2). In these studies,ultrasound (US) was used in 19 cases (56%), CT scan in 23(68%), endorectal MRI in 20 (59%), preoperative biopsy in 17(50%) and intraoperative biopsy in 1 case (3%). Explorativelaparotomy was carried out in 5 cases (15%), while cystoscopyand other modalities in 3 (9%); finally, 2 cases (6%) were foundat the time of autopsy. In 51 studies (96%), the surgicaltechnique was well defined (Table III, Figure 3). An openapproach was used in most cases, with conservativetumorectomy in 26 cases (51%) and radical cysto-prostato-vesiculectomy in 6 (12%). Laparoscopic and robotic seminalvesiculectomy (SVe) were performed in 17 (33%) and 2 (4 %)cases, respectively. Differential use of diagnostic modalities andsurgical techniques for each tumor histotype is presented inFigures 4 and 5, respectively. No perioperative complicationswere reported in the published series. Local recurrence occurredin 3 cases (6%). Nonetheless, the period of follow-up washighly variable among the studies.  Discussion and Conclusion:The first priority during the diagnostic assessment of a SVsneoplasm is to rule out primary or secondary malignancies. Theoverall preoperative evaluation is critical to choose the mostappropriate surgical treatment. MRI and preoperative biopsy arefundamental in the diagnostic work-up in order to define theanatomic relationships of the tumor and characterize its nature.MRI accurately defines the anatomic relationships of the tumor,while biopsy the characterization of its nature and,consequently, the more appropriate surgical strategy. SVe is therecommended treatment for solid masses that are benign onbiopsy, if symptomatic. Although most cases in the literaturewere managed with open surgery, nowadays, laparoscopic orrobotic SVe should be considered the gold standard treatmentsince they combine a minimally-invasive approach withexcellent oncologic outcomes. Nonethless, the overall grade ofrecommendation is currently low as the evidence is still basedon case reports and sporadic case series. 117LARGE PELVIC GOSSYPIBOMA DIAGNOSED AT THE TIME OF RADICAL PROSTATECTOMY 30 YEARS AFTER INGUINAL HERNIOPLASTYGiampaolo Siena, Riccardo Campi, Andrea Mari, Andrea Minervini, Marco Carini, Alberto Lapini and Sergio SerniDepartment of Urology, Careggi Hospital, University ofFlorence, Florence, ItalyCase Report: A 71-year-old man was referred to our centre forobstructive lower urinary tract symptoms (LUTS) and history ofa vague, chronic discomfort in the right groin and testis sincemany years. Prostate-specific antigen (PSA) level was 12 ng/dl.The diagnostic work up revealed a Gleason score 4+4=8adenocarcinoma of the prostate. No bone metastases wereAbstracts of the 25th Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 21-23 June, 2015, Rome, Italy3691Figure 5. (Abstract 116).

CURRENT STRATEGIES FOR DIAGNOSIS

AND TREATMENT OF BENIGN TUMORS

OF SEMINAL VESICLES: A SYSTEMATIC

REVIEW OF THE LITERATURE

https://flore.unifi.it/bitstream/2158/1056702/1/116.pdf

CURRENT STRATEGIES FOR DIAGNOSIS AND TREATMENT OF BENIGN TUMORS OF SEMINAL VESICLES: A SYSTEMATIC REVIEW OF THE LITERATURE

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