CURRENT STRATEGIES FOR DIAGNOSIS AND TREATMENT OF BENIGN TUMORS OF SEMINAL VESICLES: A SYSTEMATIC REVIEW OF THE LITERATURE

Introduction/Aim: Benign tumors (BT) of seminal vesicles (SV) are very rare. Diagnosis could be challenging and often requires the histopathological analysis after surgical excision. The best surgical treatment is still matter of discussion. The aim of this review is to analyze the current strategies for diagnosis and treatment of such tumors. Materials and Methods: A systematic review of English literature was performed using the Medline, Embase and Web of Science databases up to October 2014. Use of diagnostic investigations, options of surgical management, perioperative complications rate and oncologic outcomes were analyzed for each tumor histotype. Results: Fifty-eight case reports have been published in literature on BTs of SVs (Table I). Of these, 5 were excluded from the analysis due to lack of data. Cystoadenoma was found in 20 cases (38%), leiomyoma in 10 (19%), schwannoma in 8 (15%), mixed epithelial-stromal tumor in 5 (9%), phyllodes tumor in 4 (8%) and other BTs in 6 (11%) (Figure 1). Median patient age and median tumor diameter were 50 years (range=23-79) and 5.0 cm (range=2.0-29.0),respectively. In 34 papers (64%), the diagnostic work-up was accurately described (Table II, Figure 2). In these studies, ultrasound (US) was used in 19 cases (56%), CT scan in 23 (68%), endorectal MRI in 20 (59%), preoperative biopsy in 17 (50%) and intraoperative biopsy in 1 case (3%). Explorative laparotomy was carried out in 5 cases (15%), while cystoscopy and other modalities in 3 (9%); finally, 2 cases (6%) were found at the time of autopsy. In 51 studies (96%), the surgical technique was well defined (Table III, Figure 3). An open approach was used in most cases, with conservative tumorectomy in 26 cases (51%) and radical cysto-prostatovesiculectomy in 6 (12%). Laparoscopic and robotic seminal vesiculectomy (SVe) were performed in 17 (33%) and 2 (4 %) cases, respectively. Differential use of diagnostic modalities and surgical techniques for each tumor histotype is presented in Figures 4 and 5, respectively. No perioperative complications were reported in the published series. Local recurrence occurred in 3 cases (6%). Nonetheless, the period of follow-up was highly variable among the studies. Discussion and Conclusion: The first priority during the diagnostic assessment of a SVs neoplasm is to rule out primary or secondary malignancies. The overall preoperative evaluation is critical to choose the most appropriate surgical treatment. MRI and preoperative biopsy are fundamental in the diagnostic work-up in order to define the anatomic relationships of the tumor and characterize its nature. MRI accurately defines the anatomic relationships of the tumor, while biopsy the characterization of its nature and, consequently, the more appropriate surgical strategy. SVe is the recommended treatment for solid masses that are benign on biopsy, if symptomatic. Although most cases in the literature were managed with open surgery, nowadays, laparoscopic or robotic SVe should be considered the gold standard treatment since they combine a minimally-invasive approach with excellent oncologic outcomes. Nonethless, the overall grade of recommendation is currently low as the evidence is still based on case reports and sporadic case series.