Leiomyoma of the Prostate: Case Report

Leiomyoma of the Prostate: Case Report

THE JOURNAL OF UROLOGY Vol. 64, No. 2, August 1950 Printed in U.S.A. LEIOMYOMA OF THE PROSTATE: CASE REPORT RUSSELL B. CARSON Case reports are, I b...

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THE JOURNAL OF UROLOGY

Vol. 64, No. 2, August 1950 Printed in U.S.A.

LEIOMYOMA OF THE PROSTATE: CASE REPORT RUSSELL B. CARSON

Case reports are, I believe, out of place ordinarily before this Section. In the present instance perhaps the rarity of the condition justifies the departure. Leiomyomas, or smooth muscle tumors of minute size, are quite frequent findings in numerous places throughout the body and have been especially noted in the intestinal tract, kidney, ureter, bladder and elsewhere. These tumors measure a fraction of a millimeter to 1-2 mm. in diameter and are of no consequence or interest. Tumors of sufficient size to produce urologic symptoms and which pathologically are classified as leiomyomas have been found but rarely if the literature can be taken to indicate their frequency of occurrence. One quetions the frequency of occurrence when from the years 1876 to 1924, no tumors were reported and then in 1936, nine tumors were reported in the literature. The last reported case discovered in this revie,v of the literature was that of McIntyre in June 1948, and his case was classified as the twenty-second. However, in the author's review of the literature, 24 cases have been found and with the addition of this case the total is 25. CASE REPORT

On November 4, 1948 Mr. C. LaC. was first seen in our office with the chief complaint of dysuria. His symptoms began in the fall of 1947, when he developed complete retention of urine which was relieved by catheterization. He was then relatively free of urinary difficulty until about the first of October 1948, when dysuria was again experienced. He usually found it difficult to urinate upon arising in the morning but after making considerable effort and small quantities of urine during the course of a 2 or 3 hour period, voiding became less difficult and the remainder of the day he was able to urinate quite freely. On 5 occasions during the month of October he had found it impossible to urinate and was catheterized in a doctor's office. He had had no urologic examination and the cause of his difficulty had not been investigated. The patient was practically free of bowel dysfunction although he had noted that during the past year the size of the stool had decreased about one half. A review of the systems provided no additional pertinent information. In the past history the patient gave information that he had had a perineal injury when 19 years of age as a result of falling astride a joint while building a house. Swelling of the perineum and scrotum followed the injury but resolved itself without complication and without physician's treatment. In 1919 he had a hemorrhoid operation. In 1937, symptoms of gastric ulcers began and in 1939, he was operated upon for a rupture of this ulcer. He has been free of all gastro-intestinal symptoms since the operation. In 1940 a right inguinal hernia appeared and had become progressively larger. Other data of the past history and family history obtained were irrelevant to the case. Read at annual meeting, Southeastern Section, American Urologic Association, Boca Raton, Fla., March 23, 1949. 373

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RUSSELL B. CARSO"'

Physical examination revealed a very well developed, strong, white man, 65 years of age. His height was 5 ft. 8 inches, his weight 154 pounds; his temperature, pulse and respiration normal. Positive findings of interest were confined to the abdomen which revealed a 5½ inch scar just to the right of the umbilicus extending in a vertical direction. The scar was well healed. The liver, spleen and kidneys were not palpable and there was no tenderness in the region of these

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Frn.l. Leiomyoma of prostate. A, low power. B, high power.

organs. An abdominal mass existed in the lower portion of the abdomen suprapubically which was about L! finger breadths in width above the symphysis and this was assumed to be the bladder. A right indirect inguinal hernia was found to be present in the bulging mass when the patient was erect. It was about 2 inches in diameter but did not extend into the scrotum. The mass could easily be replaced through a large inguinal canal. No truss was ,vorn. Examination of the external genitalia revealed an average sized penis, meatus and urethra. The scrotum was large and pendulous and the left half of the scrotum was filled with

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a tumor which could easily be transilluminated. This hydrocele was of approximately 200 cc capacity. The perineum was normal. There were no external hemorrhoids. The tone of the anal sphincter was normal. Upon passing the examining finger into the rectum, a firm smooth mass was immediately encountered and extended upward as far as the finger could reach and laterally as far as the palpating finger could feel. There was no nodulation of the mass which occupied about two thirds of the rectal space. The mass could not be felt on deep perinea! pressure. A diagnosis of carcinoma of the prostate was made and the patient was immediately admitted to the hospital where an indwelling catheter was installed and constant drainage maintained for the next 4 days. The nonprotein nitrogen on admission was 40 mg. A cystoscopic examination revealed moderate cellule formation in a grossly trabeculated bladder. There was little posterior commissure and the lateral lobes of the prostate projected intra-urethrally about grade 2. Rectal palpation carried out while the cystoscope was in situ demonstrated that the large mass felt rectally extended from the region of the verumontanum downward to the external sphincture of the anus. It did not produce distortion of the bulb of the urethra. Perinea! prostatectomy was done on November 12, 1948 and a well incapsulated oval tumor, measuring 3¼ by 2¼ by 1¾ inches, was easily shelled out through the perineal incision. The tumor was cut in half and exhibited a fairly smooth, muscle-like surface. The tumor weighed 112 gm. The microscopic pathology (fig. 1) of the tumor was described by our pathologist as leiomyoma but containing areas in which there are many fibroblasts and some areas where marked hyalinization has taken place. The apparent origin, or at least the attachment of this tumor to the prostate, was in the region of the verumontanum. Various theories relative to the origin of leiomyomas of the prostate have been proposed. These were summarized recently by McIntyre and need not be repeated at the present time. The author does wish to point out, however, that this case would seem to support the opinion of Ewing which is to the effect that the lower remnant of the mhllerian duct ·which in the male goes to make up the prostatic utrical is of the same embryologic origin as the uterine fundus where leiomyomata are a common occurrence. For convenience of future reference, the case reports to date are listed in chronological order in the bibliography. SUMMARY

A case of leiomyoma of the prostate (weight 112 gm.) with fibroblast infiltration is presented. This case falls into the group exhibiting urinary symptoms rather than rectal obstruction. Sweet Bldg., Fort Lauderdale, Fla. LEBEC: Progres Med., 4: DA,HSKr: Ztschr. f. urol. 1

REFERENCES 1 470, 1876. Chir., 16: 47, 1924.

Arranged chronologically.

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BUGBEE, H. G.: J. Urol., 16: 67, 1926. RuBRITIUS, H.: Ztschr. f. urol. Chir., 24: 418, 1928. WOLMAN, I. J.: J. Urol., 25: 93, 1931. HINMAN, F. AND SULLIVAN, J. J.: J. Urol., 26: 475, 1931. DEUTICKE, P.: Deutsche Ztschr. f. Chir., 236: 475, 1932. DIAL, D. L. AND HALPERT, P.: Arch. Path., 16: 332, 1903. MITCHELL, D. R. AND BLAISDELL, J. L.: Brit. J. Urol., 5: 381, 1933. PATCH, F. S. AND RHEA, L. J.: Brit. J. Urol., 7: 213, 1935. PRATT, J.: New Orleans Med. & Surg. J., 88: 763, 1936. MIMPRISS, T. W.: Brit. J. Surg., 23: 863, 1936. AKIN, R.H.: Urol. & Cutan. Rev., 40: 558, 1936. KOENIG, G. H.: Urol. & Cutan. Rev., 40: 545, 1936. BARETZ, L. H.: J. Urol., 35: 664, 1936. HEGGIE, J. F.: Glasgow Med. J., 126: 223, 1936. MAGOUN, A. H.: Am. J. Surg., 44: 474, 1939. PELKONEN, A.: Acta. Chir. Scandinavica, 93: 352, 1946. McINTYRE, D. W.: J. Urol., 59: 1198, 1948. CARSON, R. B.: J. Urol., 64: July, 1950.