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Pathology for Urologists

Lymphoma


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  • Lymphomas in prostate can be primary (35%) or secondary (48%).
  • Diagnosis as primary requires that:1) lymphoma involves prostate with no or minimal involvement of periprostatic tissue; 2) symptoms are attributable to enlarged prostate; and 3) no involvement of hematopoietic system (peripheral blood, lymph nodes, liver or spleen) within 1 month of diagnosis.
  • Incidental lymphoma may be seen in prostate with or without carcinoma.
  • Symptomatic patients present mainly with obstructive urinary symptoms and occasionally with hematuria.
  • Usually in men in their 60's.
  • Cystoscopically, may show urethral luminal narrowing and bladder trabeculation indistinguishable from those seen secondary to BPH.

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  • Histology:
    • Majority of incidental and concurrent (with known disease elsewhere) prostatic lymphomas are low-grade B-cell lymphomas.
    • Most primary lymphomas are diffuse large B-cell lymphoma (55% of primary and 37% of secondary) and small lymphocytic lymphoma (18% of primary and 27% of secondary).
    • Lymphomas tend to be diffuse and involve the fibromuscular stroma.
    • In marginal zone lymphoma, lymphoid cells may infiltrate the prostatic acini and form characteristic lymphoepithelial lesions.
  • DDX: chronic prostatitis, which mimics low-grade lymphomas.
    • Unlike lymphoma, chronic prostatitis is composed of polymorphous cells (mature T and B cells, large activated B cells, plasma cells and histocytes), has infiltrates with pushing borders and often is periglandular in location.
  • Immunohistochemistry: CD45, CD20 (for B cells) and CD3 (for T cells) will highlight lymphoid monoclonality (image D).
  • Reported lymphoma specific 1 and 5 years survivals were 64% and 33%, respectively.

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