Baylor University Medical Center Proceedings July 2017 - 338

Mantle cell lymphoma of the prostate gland treated with
holmium laser enucleation
Preston A. Milburn, MD, Christian T. Cable, MD, Sean Trevathan, MD, and Marawan M. El Tayeb, MD

Mantle cell lymphoma of the prostate is rare and is seldom encountered
in general urologic practice. It either arises primarily from the prostate
or is a result of metastatic spread from another site. This specific type
of lymphoma has an aggressive course and may respond poorly to traditional chemotherapy with frequent relapses. Mantle cell lymphoma
occurs in middle age or older, which is also when symptoms of benign
prostatic enlargement begin in men. This overlap makes the diagnosis
of lymphoma of the prostate difficult and makes the treatment more
complex. We describe a case of mantle cell lymphoma of the prostate
that caused significant enlargement and bladder outlet obstruction with
urinary retention. The obstruction was treated with holmium laser enucleation of the prostate with good functional results.

ymphoma of the prostate is an exceedingly rare entity,
with less than 200 reported cases (1). Mantle cell lymphoma (MCL) of the prostate is even less common, with
only 7 reported cases (2-6). We report a case of a 59-yearold man with MCL of the prostate that was discovered after
holmium laser enucleation of the prostate.
CASE PRESENTATION
A 59-year-old man was referred by his primary care provider for progressive lower urinary tract symptoms. He had
been treated for MCL during the prior 8 years with several
clinical relapses. Initially he was treated with traditional chemotherapy, and he received chemotherapy with autologous stem
cell transplantation 2 years later for disease recurrence. He did
well for many years and was successfully treated with salvage
bendamustine/rituximab chemotherapy 6 months prior to his
prostate surgery. A follow-up computed tomography scan after
this latest treatment showed complete radiographic resolution
of his lymphoma.
Several months after completing the most recent chemotherapy, his symptoms of nocturia, hesitancy, urgency, and frequency eventually progressed to complete urinary retention. Digital
rectal exam revealed an enlarged prostate without nodules and
was overall considered benign. His prostate-speciﬁc antigen level
was 1.2 ng/mL, and gland size measured 107 cm3, which yielded
a PSA density of 0.01 ng/mL/cm3. Cystoscopy demonstrated
a 5 cm-long prostate with bilobar enlargement and grade 3
338

trabeculation of the bladder. After discussing treatment options,
the patient chose to undergo holmium laser enucleation of the
prostate for relief of his urinary obstruction.
During his surgery, the prostate tissue was very soft and
required minimal laser energy to make the incisions in the
prostatic adenoma. Establishing planes was challenging, especially in the 6 o'clock groove and lateral prostatic capsular
dissection. It took 60 minutes to enucleate the gland and 20
minutes to morcellate all of the tissue. The total weight of
enucleated tissue was 189 g. After an uncomplicated recovery in the hospital, the patient improved signiﬁcantly and
was voiding spontaneously without any residual volume on
postoperative day 1.
The resected prostate tissue was inﬁltrated by a homogenous population of medium-sized lymphoid cells with irregular
nuclear contours. The lymphoid cells were positive for Pax-5,
CD20, CD5, and Cyclin D1, consistent with recurrent MCL
(Figure). The morphological features were not suggestive of the
aggressive variants of MCL. This diagnosis was conﬁrmed by
immunohistochemistry as well as DNA ﬂuorescence in situ hybridization analysis of his previously biopsied bone marrow,
which was positive for t(11;14).
The patient was not restaged after this pathology ﬁnding.
No more chemotherapy treatments were planned, and he was
transitioned to hospice care.
DISCUSSION
Lymphoma of the prostate is exceedingly rare, with less than
200 cases reported, and the majority of cases are discovered at
autopsy (6). The largest case series comprising the pathology
database of ﬁve university hospitals spanning an aggregate of
200 years has documented only 62 cases of lymphoma of the
prostate (1). A further review of 5962 autopsy specimens revealed that only 49 (0.82%) of the patients had non-Hodgkin's
lymphoma of the prostate (3).
From the Division of Urology (Milburn, El Tayeb), Department of Oncology (Cable),
and Department of Pathology (Trevathan), Baylor Scott and White Medical Center,
Temple, Texas.
Corresponding author: Preston A. Milburn, Division of Urology, Scott and White
Clinic Desk 3A, 2401 S. 31st Street, Temple, TX 76508 (e-mail: Preston.Milburn@
BSWHealth.org).
Proc (Bayl Univ Med Cent) 2017;30(3):338-339

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings July 2017