Imaging of non-epithelial neoplasms of the prostate
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REVIEW
Imaging of non‑epithelial neoplasms of the prostate Pankaj Nepal1 · Arpit Nagar2 · Sree Harsha Tirumani3 · Vijayanadh Ojili4 Received: 26 June 2020 / Revised: 2 September 2020 / Accepted: 10 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The purpose of this article is to review the spectrum of rare non-epithelial tumors of the prostate. This focused article will help the readers to understand the imaging findings of such rare entities attributed to their clinicopathological features. Radiologists must be familiar with the spectrum of non-epithelial tumors of the prostate, which helps to suggest alternate diagnosis other than adenocarcinoma, when imaging features are atypical. This is important because these tumors have different management approaches and prognoses when compared to adenocarcinoma of the prostate. Keywords Rare · Non-epithelial · Prostate tumors · Imaging
Introduction Adenocarcinoma of the prostate represents about 95% of malignant tumors of the prostate [1, 2]. The World Health Organization (WHO) classification of prostate tumors categorizes them according to their cells of origin (Table 1) [3]. A normal prostate gland is comprised epithelial and stromal cells. Non-epithelial tumor may arise from specialized prostatic stroma, smooth muscle, neurovascular elements, periprostatic mesenchyme, paraganglia or ectopic cells such as melanocytes, hematopoietic and germ cells [4]. This histologic difference explains why prostate-specific antigen
* Vijayanadh Ojili [email protected] Pankaj Nepal Pankaj‑[email protected] Arpit Nagar [email protected] Sree Harsha Tirumani [email protected] 1
Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
2
Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
3
Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
4
Department of Radiology, University of Texas Health, San Antonio, TX, USA
(PSA) level, an epithelial serum marker is often normal in non-epithelial tumors.
Imaging modalities Various imaging modalities are available. Pelvic ultrasound can estimate the size and volume of the gland; however, it is less specific in differentiating tumor versus prostate enlargement due to benign prostate hyperplasia (BPH). Transrectal ultrasound (TRUS) uses high frequency transducer that can better delineate the focal mass, but inferior to assess extraprostatic extension. TRUS has indispensable role in image guided biopsy of the prostatic mass. Computed Tomography (CT) can estimate tumor size, detect calcifications, evaluate periprostatic disease, and lymphadenopathy. It can simultaneously evaluate distant metastases to lungs, bones and liver. While evaluating a large pelvic mass, CT may not be specific to establish the organ of origin. Multiparametric magnetic resonance imaging (MRI) can reliably determine prostatic origin of the tumor as well as pericapsular extension. T1-weighted images are best to ev
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