[Primary smooth muscle tumor in the male reproductive system: a report of 5 cases and review of the literature].

OBJECTIVE: To systematically study the clinical diagnosis and treatment of smooth muscle tumor in the male reproductive system. METHODS: We analyzed the ultrasonographic features, pathological findings, treatment strategies and postoperative follow-up results of 5 male patients with smooth muscle tumor in the reproductive system, and reviewed other relevant literature. RESULTS: Compared with leiomyoma, leiomyosarcoma exhibited stronger mixed echoes than the testis at ultrasonography, typical mitotic phase (> or = 2/10 HP) of tumor cells at HE staining, and significant expressions of HIF-1alpha and Glut-1 at immunohistochemistry. No relapse was observed in the 2 cases of leiomyoma during the 10-year follow-up after simple tumor resection, nor were recurrence and metastasis in another 3 cases of leiomyosarcoma during the first year after radical surgery without combined radio- and chemo-therapy. CONCLUSION: Primary smooth muscle tumor of the male reproductive system is difficult to be diagnosed. Ultrasonography can help to preliminarily screen leiomyosarcoma. For those with possible leiomyosarcoma, preoperative MRI and intraoperative frozen sectioning examinations are recommended for the possibility of lymphatic metastasis. Postoperative radiotherapy and chemotherapy should be chosen cautiously for those confirmed with leiomyosarcoma by pathological examination.

[Impact of neoadjuvant hormonal therapy on the permanent ¹²5I-seed brachytherapy for localized high-risk prostate cancer].

OBJECTIVE: To evaluate the impact of neoadjuvant hormonal therapy on the permanent transperineal (125)I-seed brachytherapy for localized high-risk prostate cancer. METHODS: Ten patients with T(1)-T(2a) localized high-risk prostate cancer were reviewed. The mean level of PSA was (29.4 ± 12.6) µg/L (20 - 50 µg/L) and the mean prostate volume (54 ± 33) ml. All cases were sequentially treated on a neoadjuvant hormonal therapy with 1 week of Casodex (50 mg/d) and 3 - 10 months (median: 6 months) of Casodex (50 mg/d) with Zoladex (3.6 mg per 4 weeks, SC). Then all patients received the transperineal permanent interstitial (125)I-seed implantation brachytherapy by template method. The matched peripheral dose of seed implantation was 145 Gy (median number of (125)I seeds: 46), urethral peripheral dose ≤ 80 Gy and rectal peripheral dose ≤ 60 Gy. The mean operative duration was 1.75 hours (range: 1 - 2.5 hours). RESULTS: After neoadjuvant hormonal therapy for 3 - 10 months, the PSA level decreased to (1.4 ± 0.7) µg/L in all patients. The mean prostate volume significantly decreased to (25 ± 10) ml (t-test, P < 0.01). The Foley tube extracted at Days 3 - 5 post-brachytherapy. Side effects of mild dysuria (n = 1) and urethral irritation (n = 1) were effectively managed by symptomatic treatment. After a median follow-up of 13 months (range: 3 - 24), the PSA level was (0.9 ± 0.7) µg/L. CONCLUSION: A combination of neoadjuvant hormonal therapy with brachytherapy may lower the PSA level and shrink the prostate volume so as to ensure an effective dose in the target tumor and improve the therapeutic efficacy for localized high-risk prostate cancer.