Stesura Seveso Archivio Italiano di Urologia e Andrologia 2016; 88, 166 CASE REPORT Transperitoneal laparoscopic treatment for recurrence of a giant multilocular prostatic cystadenoma: A case report and review of the literature Davide Abed El Rahman 1, Tiziano Zago 1, Giuseppe Verduci 1, Gianpaolo Baroni 1, Marco Lorenzo Berardinelli 1, Umberto Pea 2, Eugenio Morandi 3, Marco Castoldi 3 1 Urology Department, “Guido Salvini” Hospital, ASST Rhodense, Rho (MI), Italy; 2 Urology Department, “Fatebenefratelli e Oftalmico” Hospital, ASST Fatebenefratelli Sacco, Milano, Italy; 3 Surgery Department, “Guido Salvini” Hospital, ASST Rhodense, Rho (MI), Italy. Giant multilocular prostatic cystadenomas (GMPC) are very rare benign tumors that originate from the prostate with extensive spread into the pelvis. The lesion may present as large abdominal mass caus- ing obstructive voiding dysfunction and usually not invading adjacent structures. All of the previously reported patients with GMPC underwent open surgery. Although the natural history of prostatic cystadenoma remains unknown, complete surgical excision may not always be necessary. We report the case of a 74-year-old male who presented a retrovesical recurrence of prostatic cystoadenoma after 16 years, treated with a laparoscopic approach. To our knowledge this is the first case of laparoscopic management of GMPC. In this arti- cle we review the current literature about this rare tumor and discuss the diagnostic and management dilemmas posed by this rare pathologic condition. We believe that physicians should at least be aware of the existence of this disease in the differential diagnosis of pelvic cavity tumours and, consider- ing the benignity of GMPC, they should propose -as first- a minimally invasive approach. KEY WORDS: Cystadenoma; Prostate; Multilocular; Laparoscopy. Submitted 11 July 2015; Accepted 11 September 2015 Summary No conflict of interest declared. and cuboid cells with basally located nuclei and pale cytoplasm. The epithelial cells usually show positive prostatic spe - cific antigen (PSA) staining (4). Different therapeutic approaches can be employed since some authors describe total surgical excision as therapy of choice (5) due to the risk of recurrence in case of partial resection, while many others think that radical surgery is not necessary (6); it is also described a “medical” treat- ment using GnRH antagonists with excellent results (3). We report the first case – to our knowledge – of laparo- scopic treatment for a recurrent giant multilocular prosta- tic cystadenoma. CASE REPORT We report the case of a 74 years old patient - with an his- tory of hypertension and of laparotomy 16 years before for a prostatic cystoadenoma with diameter of 20 cm completely excised (Figure 1), who presented to our hos- pital complaining hypogastric pain since 3 months asso- ciated with obstructive voiding symptoms (weak urinary stream with intermittent flow) and constipation. Rectal examination revealed a large elastic mass compressing the right side of the anterior rectal wall. The patient did not report any episode of hematuria, fever or loss of weight. Baseline blood parameters at presentation iden- tified a moderately raised C-reactive protein level with a normal renal biochemistry profile and an elevated serum prostate specific antigen (PSA) of 20.5 ng/ml. A needle core biopsy showed benign prostatic tissue with no evi- dence of malignancy. Computed tomography (TC) scan showed a 11.6 x 9 x 8 cm multiloculated cystic pelvic mass with a well-defined wall compressing the right side of rectum and with heterogeneous and predominantly peripheral contrast enhancement (Figures 2-5). An exploratory laparoscopy performed through 3 trocars (12 mm prerectal right and left and 5 mm in left iliac fossa) and periumbilical camera, revealed, by using a laparoscopic ultrasound probe, a large multiloculated cystic mass arising from pelvic floor until mesosigma ori- gin; the bladder was displaced anteriorly. DOI: 10.4081/aiua.2016.1.66 INTRODUCTION Giant multilocular prostatic cistoadenoma is a rare benign tumor of the prostate gland (1, 2); it is usually characterized by large multilocular cysts located between rectum and bladder, attached to the prostate via a pedicle or, rarely, entirely separated from the prostate. It is not always possible to determine the exact point of origin of these multilocular cystic neoplasms because of their large size at the time they are diagnosed. The clinical presentation includes obstructive voiding symptoms such as poor stream, intermittency, sensation of incomplete emptying, acute urinary retention and sometimes constipation symptoms due to mechanical compression of the lower intestine (1, 3). The age of patients ranges from 15 (6) to 80 (1) years. Microscopically it is characterized by typical prostatic glands and cysts lined with double layers of columnar El Rahman_Stesura Seveso 08/04/16 11:32 Pagina 66 67Archivio Italiano di Urologia e Andrologia 2016; 88, 1 Giant multilocular prostatic cystadenoma After blunt dissection of the superior part of the cystic mass, we opened it draining more than 150 cc of dense brown liquid, we removed a large dome of the cyst (negative for malignancy at histological examination) and we proceeded with its marsupialization; similar treatment was performed for smaller neighboring cysts. The pathologic findings were consistent with giant multilocular prostatic cystadenoma. At follow up 48 months later, the patient remained free of lower urinary tract symptoms and there were no signs of recurrence. REFERENCES 1. Watanabe J, Konishi T, et al. A case of giant prostatic cystadenoma. Hinyokika kiyo. 1990; 36:1077-9. 2. Maluf HM, King ME, et al. Giant multilocular prostat- ic cystadenoma: a distinctive lesion of the retroperitoneum in men. A report of two cases. Am J Surg Pathol. 1991; 15:131-5. 3. Datta MW, Hosenpud J, et al. Giant multilocular cys- tadenomaof the prostate responsive to GnRH antagonists. Urology. 2003; 61:225. Discussion, Tables and Supplementary Refe - rences are posted on www.aiua.it Figure 1. Previous prostatic cystadenoma (16 years before). Figures 2-5. Recurrence of prostatic cystadenoma. 2. 3. 4. 5. Correspondence Tiziano Zago, MD (Corresponding Author) tzago@aogarbagnate.lombardia.it Davide Abed El Rahman, MD Giuseppe Verduci, MD Gianpaolo Baroni, MD Marco Lorenzo Berardinelli, MD Urology Department, “Guido Salvini” Hospital, ASST Rhodense, Corso Europa, 250 - Rho (MI), Italy Umberto Pea, MD Urology Department, “Fatebenefratelli e Oftalmico” Hospital, ASST Fatebenefratelli Sacco Via G.B. Grassi, 74 - Milano, Italy Eugenio Morandi, MD Marco Castoldi, MD Surgery Department, “Guido Salvini” Hospital, ASST Rhodense Corso Europa, 250 - Rho (MI), Italy El Rahman_Stesura Seveso 08/04/16 11:32 Pagina 67