Locally invasive prostate adenocarcinoma
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At the time the case was submitted for publication Mohamed Mahmoud Elthokapy had no recorded disclosures.View Mohamed Mahmoud Elthokapy's current disclosures
Pelvic pain as well as frequency, urgency of micturition and recently hematuria. Elevated PSA levels.
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A limited unenhanced CT study (due to renal functions impairment) has revealed:
- enlarged prostate gland with heterogeneous appearance and irregular margins
- signs of seminal vesicle invasion and infiltration of the adjacent posterior and inferior urinary bladder walls as well as the distal segments of both ureters more at the right side with moderate right hydroureteronephrosis secondary to ureteric orifice compromise and mild left hydroureteronephrosis
- slightly blurred pelvic fat planes surrounding the prostate and seminal vesicles as a sign of infiltration
- multiple variable sized bilateral iliac lymph nodes in the vicinity of the mass, the largest is seen on the right side and presents as a nodal mass
- moderate circumferential mural thickening of the rest of the urinary bladder walls
- right moderate scrotal hydrocele, as well as the right inguinal small encysted collection
- incidental finding of a degenerated L5-S1 disc with intra-discal vacuum phenomenon
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The prostate gland is seen markedly enlarged in size and shows heterogeneous signal intensity with irregular margins. It is seen infiltrating the seminal vesicles, adjacent posterior and inferior urinary bladder walls as well as the distal segments of both ureters more at the right side with a subsequent right distal moderate hydroureter. A tissue projection of this mass is seen abutting the anterior rectal wall. Blurred pelvic fat plane surrounding the prostate and seminal vesicles which are infiltrated.
There are bilateral iliac multiple variable-sized enlarged lymph nodes in the vicinity of the mass, the largest is seen at the right side presents as nodal mass measures 5x3 cm axially. The prostatic mass and the enlarged lymph nodes appear restricted in the diffusion study related to the high cellularity.
Moderate circumferential mural thickening of the rest of the urinary bladder walls.
Right moderate and left minimal scrotal hydrocele, as well as the right inguinal small encysted collection, are also seen.
Heterogeneous marrow signal of the examined pelvic bones.
Pelvic mass with local invasion, pathology proved prostate adenocarcinoma with regional lymphadenopathy (T4 N1 Mx).
Prostate cancer can spread by local invasion (typically into the bladder and seminal vesicles; urethral and rectal involvement are rare), lymphatic spread (pelvic nodes first followed by para-aortic and inguinal nodes), or by hematogenous metastases.
- 1. Epstein J, Egevad L, Amin M et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2016;40(2):244-52. doi:10.1097/PAS.0000000000000530 - Pubmed
- 2. Hoeks C, Barentsz J, Hambrock T et al. Prostate Cancer: Multiparametric MR Imaging for Detection, Localization, and Staging. Radiology. 2011;261(1):46-66. doi:10.1148/radiol.11091822 - Pubmed
- 3. Jeanne Held-Warmkessel. Contemporary Issues in Prostate Cancer. (2006) ISBN: 9780763730758 - Google Books
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