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Epididymal metastasis from prostatic carcinoma
EPIDIDYMAL PROSTATIC JOSEPH WILLIAM
METASTASIS
FROM
CARCINOMA
C. ADDONIZIO, THELMO,
M.D.
11.D.
From the Departments of Urology and Pathology, Westchester County Medical Cpnter-New York AMeclical College, Valhalla, New York
ABSTRACT
-
The
ninth case of prostatic
carcinoma
Metastatic carcinoma to the epididymis from prostatic carcinoma is rare. A review of the literature reveals only 8 previously reported cases . I-’ Herein, we describe an additional case with a two-year survival after diagnosis, and we review the literature. Case Report A sixty-seven-year-old white man with prostatic carcinoma was admitted with severe, incapacitating pain in his lumbosacral region and radiating down his right leg. A diagnosis of moderately difrerentiated prostatic carcinoma had been made by needle biopsy four years previously, and he was treated subsequently with estrogens and two transurethral resections for obstructive symptoms. On scrotal examination a hard, painless mass was palpable in the region of the head of the right epididymis. The mass was separate from the testis and the spermatic cord. The physical findings were otherwise within normal limits except for a hard, nodular prostate gland. Laborator\~ studies were normal, including the acid phosphatase. However. a high alkaline phosphatase level was detected. Bone scan demonstrated widespread osteoblastic metastases. On July 11, 1977, a bilateral orchiectom~ was performed with dramatic relief of pain and incapacit),. The surgical specimen consisted of the left and right testes, vasa, and epididymides. Tht
metastasizing
to the @diciyiGs
is presented,
head of the right epididymis was firm and measured 2.0 by 1.1 cm., and on cross-section was grayish-white in color (Fig. 1A). Microscopic examination of the epididymis revealed that the head was ahnost completely replaced by tumor which surrounded the ducts in sheets (Fig. 1B). The tumor cells also formed small acinar patterns, the morphologic structure not unlike that of the primary prostatic adenocarcinoma. The tumor cells had hyperchromatic nuclei, with prominent mlcleoli and scant acidophilic cytoplasm. The tumor cells tended to cluster and surround the ducts of the epididymis, and mitosis was infrequent. Both testes, \~asa, and left epididymis were uninvolved by the tumor. The pathologic diagnosis was metastatic adenocarcinoma to the right epididymis from a primary adenocarcinoma of the prostate gland. Although the patient’s clinical course over the next year was relati\rely benign, acute symptoms developed which were treated with radiotherapy and chemotherapy. He succumbed to his disease two years after discovery of the epididymal metastasis. Comment Primary carcinoma of the epididymis is rare an d usually presents between the ages of twent) and forty as a painful mass, at times conf~~scd with epididymitis. ’ Metastatic carcinoma of the epididymis. hokvever, is unco~niiio~i and mainl!
ars~~4 froiii c’iwcinomil of’ the jiastl-ointrstilinl the stonxlcll and thr colon. LfXS trac%. nanld~. fi.vquentl~ the primal-\ sites are the p’ostatc~ “’ Thv charac$eristi~ of gland or tlrc, kidne!.. inetastatic prostatic* carcinoma to dissenlinate to inost organs of’ the human lmd!, is m.ell doe~~ille~lted. In contrast to metastatic carc~inoma of the testis, \vhicli is most comnionl~ tiom the prostate gland, the epididymis is a rare rrcipient of similar metastasis. The first vase of‘ rpididymal metastasis from the prostatr mxs rereported by Hllmphrey in 1944.’ Since that report. tlrew 11a1.e lawn 7 additional owes. 6 in \\hite 111tw and 1 in a black (age range fift\,-fi\ tx to eight!.-onv !.ears). Fi\.e patients presented mass in the re\vith i1 painlc5s. hard. palpal~le gion of the t‘pididymis detected prior to surger!and histologicall~~ identified only afh cxtration for estensi\ TVprostatic cxrcinoma. In :3 c’xc5. invtastatic in\.ol\ ement was ill1 ilnr3peCted finding dllring hilaterA orchiectoni~~. There ~~2s ;iii ecp~al dihtril~ution of the lesions occ,rirring ii1 t)oth right and left epitlid~,inidt~s. anal to date 1ra\.r not hwl <‘ 1c1;\ Illd m~tastases bilateral p’1(1’ reported. Thr roilte of dissemination 01’the prostatic wrCinoma has lwen discussed thoroughl~~ in pre\.iolls reports vxcqt that the Icsion noted ii1 0i1r c’xe prolxil~l~~ 1x2s sec’ond;ir\ to eitlir7 I!~mpli;itic~ or \‘(wo~is ‘rorlte. ” Finall! . the> tliww\-er). of this rare lesion clot5
I’J I
METASTASIS
FROM
CARCINOMA
C. ADDONIZIO, THELMO,
M.D.
11.D.
From the Departments of Urology and Pathology, Westchester County Medical Cpnter-New York AMeclical College, Valhalla, New York
ABSTRACT
-
The
ninth case of prostatic
carcinoma
Metastatic carcinoma to the epididymis from prostatic carcinoma is rare. A review of the literature reveals only 8 previously reported cases . I-’ Herein, we describe an additional case with a two-year survival after diagnosis, and we review the literature. Case Report A sixty-seven-year-old white man with prostatic carcinoma was admitted with severe, incapacitating pain in his lumbosacral region and radiating down his right leg. A diagnosis of moderately difrerentiated prostatic carcinoma had been made by needle biopsy four years previously, and he was treated subsequently with estrogens and two transurethral resections for obstructive symptoms. On scrotal examination a hard, painless mass was palpable in the region of the head of the right epididymis. The mass was separate from the testis and the spermatic cord. The physical findings were otherwise within normal limits except for a hard, nodular prostate gland. Laborator\~ studies were normal, including the acid phosphatase. However. a high alkaline phosphatase level was detected. Bone scan demonstrated widespread osteoblastic metastases. On July 11, 1977, a bilateral orchiectom~ was performed with dramatic relief of pain and incapacit),. The surgical specimen consisted of the left and right testes, vasa, and epididymides. Tht
metastasizing
to the @diciyiGs
is presented,
head of the right epididymis was firm and measured 2.0 by 1.1 cm., and on cross-section was grayish-white in color (Fig. 1A). Microscopic examination of the epididymis revealed that the head was ahnost completely replaced by tumor which surrounded the ducts in sheets (Fig. 1B). The tumor cells also formed small acinar patterns, the morphologic structure not unlike that of the primary prostatic adenocarcinoma. The tumor cells had hyperchromatic nuclei, with prominent mlcleoli and scant acidophilic cytoplasm. The tumor cells tended to cluster and surround the ducts of the epididymis, and mitosis was infrequent. Both testes, \~asa, and left epididymis were uninvolved by the tumor. The pathologic diagnosis was metastatic adenocarcinoma to the right epididymis from a primary adenocarcinoma of the prostate gland. Although the patient’s clinical course over the next year was relati\rely benign, acute symptoms developed which were treated with radiotherapy and chemotherapy. He succumbed to his disease two years after discovery of the epididymal metastasis. Comment Primary carcinoma of the epididymis is rare an d usually presents between the ages of twent) and forty as a painful mass, at times conf~~scd with epididymitis. ’ Metastatic carcinoma of the epididymis. hokvever, is unco~niiio~i and mainl!
ars~~4 froiii c’iwcinomil of’ the jiastl-ointrstilinl the stonxlcll and thr colon. LfXS trac%. nanld~. fi.vquentl~ the primal-\ sites are the p’ostatc~ “’ Thv charac$eristi~ of gland or tlrc, kidne!.. inetastatic prostatic* carcinoma to dissenlinate to inost organs of’ the human lmd!, is m.ell doe~~ille~lted. In contrast to metastatic carc~inoma of the testis, \vhicli is most comnionl~ tiom the prostate gland, the epididymis is a rare rrcipient of similar metastasis. The first vase of‘ rpididymal metastasis from the prostatr mxs rereported by Hllmphrey in 1944.’ Since that report. tlrew 11a1.e lawn 7 additional owes. 6 in \\hite 111tw and 1 in a black (age range fift\,-fi\ tx to eight!.-onv !.ears). Fi\.e patients presented mass in the re\vith i1 painlc5s. hard. palpal~le gion of the t‘pididymis detected prior to surger!and histologicall~~ identified only afh cxtration for estensi\ TVprostatic cxrcinoma. In :3 c’xc5. invtastatic in\.ol\ ement was ill1 ilnr3peCted finding dllring hilaterA orchiectoni~~. There ~~2s ;iii ecp~al dihtril~ution of the lesions occ,rirring ii1 t)oth right and left epitlid~,inidt~s. anal to date 1ra\.r not hwl <‘ 1c1;\ Illd m~tastases bilateral p’1(1’ reported. Thr roilte of dissemination 01’the prostatic wrCinoma has lwen discussed thoroughl~~ in pre\.iolls reports vxcqt that the Icsion noted ii1 0i1r c’xe prolxil~l~~ 1x2s sec’ond;ir\ to eitlir7 I!~mpli;itic~ or \‘(wo~is ‘rorlte. ” Finall! . the> tliww\-er). of this rare lesion clot5
I’J I