报道一例以持续性血精为首发症状的原发性精囊腺癌，提高对该疾病的认识。

回顾性分析我院收治的1例以持续性血精为首发症状的原发性精囊腺癌临床资料，结合文献对其诊治方案及预后进行复习。患者年龄40岁，因持续性血精保守治疗效果不佳于外院接受精囊镜手术治疗，术后三个月血精仍未愈，且出现晨起间歇性初始肉眼血尿。遂转至我院再次行精囊镜手术治疗，镜检见双侧精囊积血并左侧精囊内菜花样新生物，钳取病变组织送病理检查示精囊腺癌。后续增强MR及PET/CT提示左侧精囊癌并同侧盆腔淋巴结转移，遂行机器人辅助腹腔镜精囊前列腺根治性切除+盆腔淋巴结清扫术。

术后病理证实为双侧原发性精囊腺癌，左侧髂血管旁淋巴结见转移癌。术后半年复查PET/CT无复发。1年后再次行PET/CT和MR检查，提示右侧盆腔淋巴结转移灶，原手术切除部位局部无复发，即行挽救性右侧盆腔淋巴结清扫术，术后辅以放化疗。首次根治术后1年半再次复查PET/CT，提示右侧盆腔术区肿瘤复发，目前仍在随访中。

原发性精囊腺癌临床罕见，恶性程度高，预后差。临床上多以持续性血精伴有或无血尿为首发症状，因其发病率低而易误诊，应重视。治疗以根治性手术切除为主，术后可辅助化疗或放疗等综合治疗，疗效有待观察。术后易复发，应密切随访。

To report a case of primary seminal vesicle adenocarcinoma (PSVA) presenting with persistent hematospermia as the initial symptom to enhance awareness of this disease.

The data of the patient with PSVA initially presenting with persistent hematospermia treated in our hospital was retrospectively analyzed, with a review of its management strategies and prognostic features based on literature. The 40-years-old patient underwent transurethral seminal vesiculoscopy at an external hospital after failed conservative treatment for persistent hematospermia. Three months postoperatively, hematospermia persisted with new-onset intermittent initial gross hematuria upon waking. The patient was transferred to our center for repeat seminal vesiculoscopy, which revealed hemorrhagic bilateral seminal vesicles and a cauliflower-like mass in the left seminal vesicle. Pathological examination of biopsied tissue confirmed seminal vesicle adenocarcinoma. Subsequent contrast-enhanced MRI and PET/CT revealed left seminal vesicle adenocarcinoma with ipsilateral pelvic lymph node metastasis. The patient underwent robot-assisted laparoscopic radical seminal vesiculectomy with prostatectomy and pelvic lymphadenectomy.

Histopathology confirmed bilateral PSVA infiltrating the prostate, with metastatic adenocarcinoma in the left external iliac lymph node. Follow-up PET/CT at 6 months postoperatively showed no recurrence. One year later, repeat PET/CT and MRI demonstrated right pelvic lymph node metastasis without local recurrence at the primary resection site. Salvage right pelvic lymphadenectomy was performed followed by adjuvant chemoradiotherapy. Follow-up PET/CT scan 1.5 years postoperatively demonstrated tumor recurrence in the right pelvic surgical bed. The patient is currently under ongoing follow-up.

PSVA is an exceptionally rare malignancy with aggressive biological behavior and poor prognosis. Clinically, it most frequently manifests with persistent hematospermia with or without concomitant hematuria as the initial symptom. Due to its exceedingly low incidence, misdiagnosis is common, necessitating heightened clinical vigilance. Radical surgical resection constitutes the cornerstone of treatment. Adjuvant therapies such as chemotherapy or radiotherapy may be considered postoperatively, though their therapeutic outcomes warrant further investigation. Postoperative recurrence remains frequent, mandating close long-term surveillance.