Leiomyoma of the prostate gland

LEIOMYOMA OF THE PROSTATE GLAND JAMES

A.

H.

MAGOUN,

Director of Surgery, FIower Hospital;

I

N spite of the reports in the Iiterature cases there

F.A.C.S.

Chief of Urologic Staff, Lucas County Hospital

TOLEDO,

eighteen prostate,

M.D.,

of of Ieiomyoma of the is stiI1 some question

OHIO

1924; Bugbee in 1926; VignoIo, Rubritus in and 1928; WoIman in rg3 I ; Hinman SuIIivan (2) in rg3 I ; Deuticke in 1932; DiaI

FIG. I. Gross specimen, showing growth associated with bladder and rectum.

HaIpert (3) in 1933; _and _-_ __. _Frank Patch and L. J. Rhea in 1935 ; MitcheII and BIaisdeII, 1936; R. H. Akin, 1936; Koenig, 1936; L. H. Baretz 1936; and Mimpriss in 1936. The foIIowing case is added to the above :

concerning the true nature and origin of these neopIasms. Tumors of this character may arise from any of the fibromuscuIar tissues found in this region, i.e., prostate, bIadder, recta1 waI1, and the retroperitonea tissues. In Igzo, I reported the history of a patient afflicted with a tumor of this nature arising from the retroperitonea1 tissue behind the rectum. However, it wouId seem from the embryoIogic deveIopment of the prostate and the amount of muscIe tissue found normaIIy in it, that a Ieiomyoma occurring in this location wouId more IikeIy arise from the prostate than from the other tissues mentioned. Again an entity of diffuse muscuIar hyperplasia may occur in the prostate reveaIing a microscopic picture very simiIar to that of Ieiomyoma. Such a case was reported by me in 1930. Occasiona cases of Ieiomyoma of the prostate have been reported-by Lebec in 1876; Damski in

M. S., a white maIe, about sixty years of age, was admitted to the hospita1 on November 6, 1934. He stated that about six weeks before he became constipated and began to use cathartics: At first these gave reIief, but the constipation had gradually become wor$e and during the past seven days he had had no bowel movement. About three months before he began to suffer with nocturia. Six weeks before he noticed a Iarge amount of bIood in the urine but there had been no hematuria since then. PhysicaI examination reveaIed a fairIy we11 preserved aduIt male apparentIy not suffering any pain. Examination of the heart and Iungs was negative. The abdomen was not distended, but the bIadder was paIpabIe we11 above the pubis. To the right of the bIadder there was a 474

NEW SERIES VOL. XLIV.

No. 2

Magoun-Prostate

Iarge firm mass apparentIy fiIIing the pelvis. Proctoscopic examination revealed the mucosa of the rectum to be normaI. The systoIic bIood pressure was 220, the diastolic 90. The hemoglobin was 87 per cent, R. B. C. q,ggo,ooo, W.B.C. ~o,qoo. The urine showed a trace of aIbumin, an occasional white blood celI and a few red blood ceIIs. A coIostomy was performed, but there was no attempt to ascertain the nature of the mass. FoIlowing the operation the patient became mudh worse and passed away a few days later. At autopsy the mass feIt in the Iower abdomen was found to arise from the base of the bladder, almost entirely replacing the prostate. It extended we11 up behind the posterior bIadder waI1 and nearIy surrounded the rectum. It weighed 1450 Gm. Of the eighteen cases previousIy reported, thirteen had chiefly urinary symptoms, four primariIy recta1 or perinea1 manifestations, and one had painfu1 erections as a chief symptom. The case reported is unique in the fact that the obstipation had progressed to the point where there had been no bowel movement for a week

FIG. 3. Photomicrograph, low power, showing marginal area of tumor to capsule.

and the surgeon in charge considered a coIostomy indicated to reIieve it. Two types of these tumors appear to occur: one, massive in size, invoIving and obscuring the prostate and fiIIing the peIvis

GIand

American Journal of Surgery

175

and surrounding the rectum; the other, sometimes pedunculated, may be closeIy associated with the urethra and bIadder

FIG. 2. Photomicrograph

of growth,

low power.

and cause obstruction of the bIadder or ejacuIatory ducts, as in the case reported by Akin, or the peduncuIated tumor may extend into the surrounding prostatic

FIG.

3. Photomicrograph power.

tissue as Hinman muItipIe gIanduIar prostate

of growth,

high

in one of the cases reported by and SuIIivan. The very smaI1 myomatous noduIes situated in or adenomatous areas of the have not been considered. The

476

AmericanJournalof Surgery

case herein type.

reported

Magoun-Prostate

is of the

massive

SUMMARY

A report is given of a patient afllicted with massive Ieiomyoma of the prostate, causing obstipation. A brief review of the Iiterature and pathologic studies are incIuded. REFERENCES mbd., 4: 471, 1876. DAMSKI, A. Ztscbr. j. urol. Cbir., 16: 47, 1924.

LEBEC. hog.

Gland

MAY, 1939

BUGBEE, H. G. J. Ural., 16: 67, 1926. VIGNOLO. Quoted in BIum and Rubritius. RUBRITIUS, H. Ztscbr. f. urol. Cbir., 24: 418,

1928. WOLMAN, I. J. J. Ural., 25: 93, 1931. HINMAN and SULLIVAN: J. Ural., 26: 475, 1931. MITCHELL and BLAISDELL. Brit. J. Ural., 5: 381-383

(Dec.) 1933.

f. Cbir., 236: 475, 1932. Patb., 16: 332-339. Cut. Rev., August, 1936. Cut. Rev., August, 1936. PATCH,FRANK S., and RHEA, L. J. Brit. J. Ural., 7:

DEUTICKE. Deutscbe Arch. DIAL and HALPERT. Arch. AKIN, ROBERT A. Ural. @ KOENIG, GEO. H. Ural. @

213-228. BARE-CZ, L. H. J. Ural., June, 1936. MIMPRISS,T. W. &it. J. Surg., 23: 863-865 ~936.

IN the city of BoIogna, Italy, there Iives an orthopedic surgeon by the name of Putti. He has educated the mothers of that vicinity genital disIocation

of the hip is very common]

[where con-

to Iook for the deformity

and find it long before the child begins to walk. His results are reported the best in the world. From-“From

Head to Foot”

by Armitage

Whitman

(Farrar & Rinehart).

(April)