Hypothesis / aims of study
A 73-year-old male presents as a rare case of B-cell lymphoma involving the prostate. He had a history of benign prostatic hyperplasia (BPH) and underwent transurethral resection of the prostate (TURP) for severe lower urinary tract symptoms (LUTS).
Histopathology from the TURP procedure was reported as benign stromal hyperplasia but also a lymphocytic infiltrate, predominantly B-cells, highly suspicious of low-grade B-cell lymphoma. Further evaluation with Immunohistochemistry confirmed the presence of B-cells (CD20 and CD79a positive) without co-expression of CD5 or BCL-6.
PET/CT imaging showed an FDG-avid prostate lesion with a maximum SUV of 33.6, but no definitive evidence of lymphadenopathy was detected. MRI findings suggested post-TURP changes with an indeterminate lesion in the left peripheral zone, possibly representing chronic infection. The patient’s PSA levels, monitored regularly due to his history of prostate hyperplasia, remained stable at around 0.7 ng/mL.
Following surgery, the patient reported significant improvement in his lower urinary tract symptoms and expressed satisfaction with the outcomes. He is currently following up with his hematologist for further evaluation for his lymphoma.
This case study highlights that LUTS are nonspecific and can indicate a range of conditions, including both common benign and rare malignant prostatic diseases. It will also show the importance of immunohistochemistry in confirming the presence of prostatic lymphoma and identifying its specific type based on the markers
Study design, materials and methods
Less than 0.1% of all prostate malignancies are primary lymphomas, making them an uncommon condition (1), B-cell lymphoma involving the prostate typically presents with non-specific symptoms such as Lower Urinary Tract Symptoms (LUTS), which can mimic Benign Prostatic Hyperplasia (BPH) or other more common prostate conditions (2).
The majority of cases are diagnosed incidentally following prostate biopsy or transurethral resection of the prostate (TURP) (3). Since primary prostatic lymphoma cases are rare and not usually included in the differential diagnosis for LUTS, they frequently cause delays in diagnosis (4). Histologically, prostatic lymphoma is usually composed of diffuse large B-cell lymphoma (DLBCL) or low-grade B-cell lymphomas, with the latter being even rarer (1).
Immunohistochemical staining is essential for confirming the diagnosis, with typical markers including CD20 and CD79a for B-cells (5). Additionally, monitoring prostate-specific antigen (PSA) levels can assist in evaluating prostate disease progression (6).
Imaging, particularly with PET/CT, can further aid in evaluating the extent of disease and potential metastasis (7).
Early diagnosis is crucial for initiating appropriate therapy, which may involve chemotherapy, radiotherapy, or a combination of both, depending on the stage of the disease (8).
Results
This case report describes a rare instance of suspected B-cell lymphoma involving the prostate in a 73-year-old male, diagnosed after TURP for BPH. The diagnosis was confirmed through histopathology examination of the TURP chips, with further immunohistochemistry evaluation, PET/CT imaging, and stable PSA levels. Although rare, prostatic lymphoma should be considered in elderly males presenting with LUTS, especially when routine treatments fail. Early diagnosis and appropriate treatment are essential for improving outcomes.
Interpretation of results
This case report describes a rare instance of suspected B-cell lymphoma involving the prostate in a 73-year-old male, diagnosed after TURP for BPH. The diagnosis was confirmed through histopathology examination of the TURP chips, with further immunohistochemistry evaluation, PET/CT imaging, and stable PSA levels. Although rare, prostatic lymphoma should be considered in elderly males presenting with LUTS, especially when routine treatments fail. Early diagnosis and appropriate treatment are essential for improving outcomes.