Prostate cancer and proctitis

Case contributed by Ali Alsmair


Known history of prostate cancer with left neurovascular bundle invasion and questionable anterior rectum invasion (diagnosed 1 year ago), presented with chronic constipation and blood in the stool. No history of radiotherapy.

Patient Data

Age: 85 years
Gender: Male

There is diffuse smooth thickening of the lower rectum, involving a segment measuring about 6 cm in length, with mucosal diffusion restriction.  Perirectal fat stranding is noted.

Features are consistent with proctitis.

 The known prostatic left peripheral zone malignant lesion seems to invade the left neurovascular bundle, left seminal vesicles and left anterior lower rectum.

Case Discussion

Histopathology report:

Gross description:
The specimen consists of nine tiny fragments.

Microscopic description:
Sections show colonic mucosa with diffuse hyperplastic changes.
Two fragments show fibrohyalinization in the lamina propria with mild hemosiderin pigment. The small capillaries are dilated, but no thrombi seen. Chronic inflammation is mild.
There is no cryptitis. No granuloma. No ulceration.
There is no dysplasia or invasive malignancy.

Benign histology with focal fibrosis, suggestive of old ischemia.


The findings indicate a non-specific proctitis, not due to acute ischemia, infection, inflammatory bowel disease or radiation. This study also demonstrates extracapsular invasion of prostate cancer into the left neurovascular bundle, seminal vesicles, and left anterior rectal wall.

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