Ductal adenocarcinoma of the prostate with endometrioid features in a 69-year-old man

We describe a case of ductal adenocarcinoma of the prostate with endometrio id characteristics presenting as painless hematuria and intraurethral tumor . A 69-year-old man had intermittent painless hematuria for 2 months. The s erum prostate-specific antigen concentration vas elevated (22.0 ng/mL). An enlarged prostate with a necrotic tumor ms noted in the right lobe of the p rostate on computerized tomography and magnetic resonance imaging studies. A polypoid and worm-like tumor was found within the prostatic urethra near the verumontanum. The tumor had a distinctly papillary configuration vith a focal glandular structure on microscopy. Radical prostatectomy vas perform ed and histology of the tumor specimen revealed it to be composed of a clos ely packed glandular structure lined by single layers of high columnar cell s with focal stratification. Frequent papillary projections of glandular ep ithelium and intraglandular bridging were noted, with a histopathologic app earance similar to endometrioid carcinoma of the uterus. Androgen deprivati on therapy was started immediately follow ring surgery. No evidence of recu rrence or metastasis was found at follow-up 27 months postoperatively. Dist inct features of ductal adenocarcinoma of the prostate include intraurethra l papillary tumor close to the verumontanum, urethral obstruction, and easy bleeding of the tumor. Its more aggressive behavior than classical microac inar adenocarcinoma of the prostate makes early recognition of this type of prostatic malignancy important.