Poorly differentiated neuroendocrine carcinoma of
the seminal vesicle
Yutaka Yasunaga,1Takafumi Ueda,2Yoshinori Kodama3and Toshitsugu Oka1
Departments of1Urology,2Orthopedics and3Pathology, National Hospital Organization Osaka National Hospital, Osaka, Japan
Abbreviations & Acronyms
NEC = neuroendocrine
NET = neuroendocrine
NSE = neuron-specific
PSA = prostate-specific
SV = seminal vesicle
Yasunaga M.D., Ph.D.,
Department of Urology,
National Hospital Organization
Osaka National Hospital,
1-24-41 Hoenzaka, Chuo-ku,
Osaka 540-0006, Japan. Email:
Received 12 August 2011;
accepted 4 December 2011.
Online publication 29 December
humeral bone tumor resulting in a pathological fracture. Positron emission tomography
vesicle. Laboratory data showed an elevation of neuron-specific enolase, despite the
normal prostate-specific antigen. Transrectal needle biopsy showed a poorly differenti-
ated carcinoma of the right seminal vesicle and the metastasis of the pelvic lymph node.
Immunohistochemical results were compatible with the features of neuroendocrine car-
cinoma; synaptophysin, chromogranin A and CD 56 were positive. The previously biop-
sied bone tumor was finally diagnosed as a metastasis. A systemic chemotherapy using
etoposide and cisplatin failed. The patient died of cancer one-and-a-half years later.
We describe an extremely rare case of poorly differentiated neuroendo-
neuroendocrine carcinoma, poorly differentiated, seminal vesicle.
Primary tumors of the seminal vesicle are uncommon. Exclusively, NET arising from the
seminal vesicle is extremely rare. Here, we show a case of poorly differentiated NEC of the
seminal vesicle with bone metastasis, and discuss the problems related to the diagnosis and
treatment of this tumor.
A 67-year-old man presented at the Department of Orthopedics with a left upper arm tumor
resulting in a pathological fracture. A needle biopsy of the left humeral bone disclosed an
undifferentiated carcinoma. A subsequent positron emission tomography scan using fluo-
rodeoxy glucose as a tracer to screen the primary site of the carcinoma showed the hot spot
accumulated behind the urinary bladder, suspected to be in either the prostate or seminal
vesicle. An additional examination including chest X-ray and abdominal computed tomog-
raphy scan resulted in no other abnormal findings as the primary site. The patient was then
referred to the Department of Urology, and examined physically and clinically. The digital
rectal examination showed an enlarged prostate with a smooth surface.A large mass behind
the right lobe of the prostate was also palpable without apparent distinction from the right
SV. Transrectal ultrasonography showed an irregular tumor in the right SV extending to the
prostate, as well as a large lymph node swelling in the pelvic cavity. Magnetic resonance
imaging scan also featured a large, 4 cm in size and irregular tumor of the right SV (Fig. 1)
accompanying lymph node metastasis aside the right internal iliac artery, and additional
bone metastases in the lumbar and sacral regions.
Laboratory tests showed anemia (hemoglobin 11.4 g/dL and hematocrit 34.9%) and
elevations of C-reactive protein (6.53 mg/dL), and alkaline phosphatase (419 IU/L) with a
antigen, squamous cell carcinoma antigen, CA19-9 and CA125 were all within the normal
range, showing 1.4 ng/mL, 1.3 ng/mL, 7 U/mL and 9.3 U/mL, respectively. PSA was also at
normal levels (1.72 ng/mL). NSE was the only positive tumor marker (22.0 ng/mL).
International Journal of Urology (2012) 19, 370–372 doi: 10.1111/j.1442-2042.2011.02944.x
© 2011 The Japanese Urological Association