Salvage Robotic-Assisted Seminal Vesiculectomy for Merkel Cell Carcinoma Metastasis.

A 71-year-old male presented with Merkel cell carcinoma along with inguinal lymph node involvement (stage III). The patient was proposed for systemic treatment followed by inguinal lymphadenectomy and adjuvant radiotherapy. During the follow-up period, recurrences were documented (lymphatic and visceral) and were treated with salvage surgery and radiotherapy. On the fifth year of follow-up the patient was diagnosed with a metastasis in the right seminal vesicle and underwent stereotactic body radiation therapy. Two-years later, tumor recurrence in the right seminal vesicle was managed with salvage robotic assisted seminal vesiculectomy. Advanced stages of Merkel cell carcinoma have a poor outcome and salvage treatments should be tailored to each patient. A multidisciplinary approach was crucial in achieving successful outcomes. The patient is still recurrence free twenty-four months after surgery. To the best of our knowledge, this is the first publication reporting a seminal vesical Merkel cell metastasis.

Doente do sexo masculino de 71 anos, com carcinoma de células de Merkel com metastização ganglionar inguinal (estádio III), submetido a terapêutica sistémica seguida de linfadenectomia inguinal e radioterapia adjuvante. Durante o seguimento, todas as recorrências foram tratadas com radioterapia ou cirurgia de salvação. Cinco anos após o diagnóstico inicial, o doente foi diagnosticado com uma metástase na vesicula seminal direita, tendo sido tratado com radioterapia estereotáxica corporal. Dois anos mais tarde, por nova recorrência do tumor na vesicula seminal direita, foi submetido a uma vesiculectomia seminal robótica de salvação. Estádios avançados do carcinoma de células de Merkel apresentam um prognóstico reservado e os tratamentos de salvação devem ser adaptados a cada doente. Uma abordagem multidisciplinar revelou-se crucial para o sucesso do caso. O doente encontra-se no vigésimo quarto mês de pós-operatório, sem evidência de recidiva de doença. Até à data, este é o primeiro caso descrito de metástase na vesicula seminal de carcinoma de células de Merkel.

Prostate Leiomyosarcoma: A Rare Misleading Tumor.

CASE REPORT: 73 year-old patient present with lower urinary tract symptoms (LUTS) and a low serum prostate specific antigen (PSA) diagnosed with a prostate leiomyosarcoma following a TURP. Afterwards, he was submitted to radical prostatectomy. A multimodal approach with radiotherapy was considered although death occurred less than three months after surgery. DISCUSSION: Prostate leiomyosarcoma is a rare aggressive tumour with misleading clinical features which may delay the diagnosis. The rarity of prostate sarcomas makes it very difficult to have prospective studies and appropriate clinical research. Therefore, it is of the utmost importance to report its occurrence in order to improve our knowledge of its natural history. There are no guidelines concerning an optimal treatment. When feasible, surgery is the mainstay of treatment. Notwithstanding, recently published data favour multimodal therapies for the treatment of prostatic sarcomas, particularly for locally advanced disease.