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Local seeding of anaplastic carcinoma of prostate after needle biopsy
LOCAL SEEDING OF ANAPLASTIC CARCINOMA OF PROSTATE AFTER NEEDLE BIOPSY M. BRAUSI, M .D . A . LATINI, M .D . E D . PALLADINI, M .D. From the Department of Urology, `B . Ramazzini" Hospital, Carpi (Modena), Italy
ABSTRACT-We present the seventh case of perinea) localization of anaplastic carcinoma after needle biopsy of the prostate . The patient first had cryosurgery and bilateral orchiectom .y followed by hormonal therapy (estrogens) and chemotherapy . The surgical excision of the mass was performed, but he died a few days later of metastatic disease .
The most commonly used procedure for obtaining a biopsy of the prostate is the perineal method . Since 1974, only 6 cases of perineal seeding using this technique have been reported in the literature . We herein report a seventh case. Case Report A fifty-three-year-old man was admitted to Ospedale Ramazzini in February 25, 1977, with the chief complaint of urinary bladder retention . Rectal examination revealed a diffusely indurated and irregular prostate with involvement of the seminal vesicles . Findings on renal function tests and alkaline and acid phosphatase were all within normal limits . Chest x-ray films and intravenous pyelogram were normal . There was no evidence of metastatic disease on the bone scan . Endoscopic examination of the prostate revealed the medium lobe slightly enlarged . A bilateral perineal biopsy was performed with a Trucut needle . The pathologic diagnosis was "anaplastic carcinoma of the prostate" (Fig. IA) . On March 3, cryosurgery (CE-4 Frigitronics) followed by bilateral orchiectomy were performed .
UROLOGY
1
JANUARY 1986
One month after the initial biopsy, the patient complained of diffused perineal pain . At this time, physical examination revealed a 2 by 3-cm hard nodule on the right side of the anus along the needle track of the previous biopsy (Fig . 1B) . The mass was excised . Histologic diagnosis was "perineal metastasis from anaplastic carcinoma of the prostate" (Fig . 1C) . The margins of the local nodule were free of tumor. A short time thereafter the patient's general physical condition worsened . Liver scan revealed metastatic disease . Scrotal edema, tumor involvement of the penis (corpora cavernosa), and bilateral inguinal node enlargement developed . The patient was treated with ethinyl estradiol followed by a course of doxorubicin (Adriamycin) and cyclophosphamide (Endoxan) intravenously. There was no improvement, and the patient died shortly thereafter. Comment The incidence of local metastases after perineal needle biopsy for prostatic cancer is low (0 .2 % 1 z) . The recurrence of tumor in the perineum is variable, ranging anywhere from five
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FIGURE 1 .
(A) Histopathologic specimen showing anaplastic carcinoma of prostate . (B) Perineal nodule ; diameter is 2 by 3 cm . (C) Perineal nodule biopsy specimen showing anaplastic carcinoma invading perineal tissues .
months to seven years . In our patient we observed this occurrence one month after the initial biopsy. A review of literature demonstrates poorly differentiated or undifferentiated carcinoma of the prostate but not of anaplastic pattern . Clinically, metastatic localization usually appears as a hard perineal node measuring from 0 .2 to 5 cm in diameter (in our patient 2 x 3 cm) firmly attached to the skin . Since the incidence of local metastases is variable, the patient who presents with poorly differentiated prostatic carcinoma after perineal needle biopsy should be carefully monitored especially one month up to one year after the initial diagnosis . In our case, the appearance of the perineal metastatic nodule only one month after biopsy was accompanied by a worsening of the patient's condition and hence, may represent a poor prognosis . We believe the best treatment for this type of cancer recurrence is radical excision of the mass . However, if margins of enucleation are not free of tumor, then radical excision with so-
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pervoltage radiation to the perineum should be the mode of therapy. We still feel that the perineal needle biopsy is the best method for histologic diagnosis since the incidence of metastatic seeding is low, even though, in our case, it led to perineal localization of the cancer. Via Tonelli 16 41012 Carpi (MO) Italy References 1 . Blackard CE, Soucheray JA, and Gleason DF : Prostatic needle biopsy with perineal extension of adenocarcinoma, J Urol 106 :401 (1971) . 2 . Desai SG, and Woodruff LM : Carcinoma of prostate : local extension following perineal needle biopsy, Urology 3 : 87 (1974) . 3 . Kaufman JJ, and Schultz JI : Needle biopsy of the prostate : a reevaluation, J Urol 87 : 164 (1962) . 4 . Clark BG, Lcadbetter WF, and Campbell JS : Implantation of the prostate in site of needle biopsy : report of a case, ibid 70 : 937 (1953) . 5 . Goldman EJ, and Samellas W: Local extension of carcinoma of the prostate following needle biopsy, ibid 84 : 575 (1960) . 6 . Labardini MM, and Nesbit EM : Perineal extension of adenocarcinoma of the prostate gland after punch biopsy, ibid 97 : 891 (1967) . 7 . Fortunoff S : Needle biopsy of prostate, a review of 346 biopsies, ibid 87 : 159 (1962) .
UROLOGY
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JANUARY 1986
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VOLUME XXVII, NUMBER 1
ABSTRACT-We present the seventh case of perinea) localization of anaplastic carcinoma after needle biopsy of the prostate . The patient first had cryosurgery and bilateral orchiectom .y followed by hormonal therapy (estrogens) and chemotherapy . The surgical excision of the mass was performed, but he died a few days later of metastatic disease .
The most commonly used procedure for obtaining a biopsy of the prostate is the perineal method . Since 1974, only 6 cases of perineal seeding using this technique have been reported in the literature . We herein report a seventh case. Case Report A fifty-three-year-old man was admitted to Ospedale Ramazzini in February 25, 1977, with the chief complaint of urinary bladder retention . Rectal examination revealed a diffusely indurated and irregular prostate with involvement of the seminal vesicles . Findings on renal function tests and alkaline and acid phosphatase were all within normal limits . Chest x-ray films and intravenous pyelogram were normal . There was no evidence of metastatic disease on the bone scan . Endoscopic examination of the prostate revealed the medium lobe slightly enlarged . A bilateral perineal biopsy was performed with a Trucut needle . The pathologic diagnosis was "anaplastic carcinoma of the prostate" (Fig. IA) . On March 3, cryosurgery (CE-4 Frigitronics) followed by bilateral orchiectomy were performed .
UROLOGY
1
JANUARY 1986
One month after the initial biopsy, the patient complained of diffused perineal pain . At this time, physical examination revealed a 2 by 3-cm hard nodule on the right side of the anus along the needle track of the previous biopsy (Fig . 1B) . The mass was excised . Histologic diagnosis was "perineal metastasis from anaplastic carcinoma of the prostate" (Fig . 1C) . The margins of the local nodule were free of tumor. A short time thereafter the patient's general physical condition worsened . Liver scan revealed metastatic disease . Scrotal edema, tumor involvement of the penis (corpora cavernosa), and bilateral inguinal node enlargement developed . The patient was treated with ethinyl estradiol followed by a course of doxorubicin (Adriamycin) and cyclophosphamide (Endoxan) intravenously. There was no improvement, and the patient died shortly thereafter. Comment The incidence of local metastases after perineal needle biopsy for prostatic cancer is low (0 .2 % 1 z) . The recurrence of tumor in the perineum is variable, ranging anywhere from five
1 VOLUME XXVII, NUMBER 1
63
FIGURE 1 .
(A) Histopathologic specimen showing anaplastic carcinoma of prostate . (B) Perineal nodule ; diameter is 2 by 3 cm . (C) Perineal nodule biopsy specimen showing anaplastic carcinoma invading perineal tissues .
months to seven years . In our patient we observed this occurrence one month after the initial biopsy. A review of literature demonstrates poorly differentiated or undifferentiated carcinoma of the prostate but not of anaplastic pattern . Clinically, metastatic localization usually appears as a hard perineal node measuring from 0 .2 to 5 cm in diameter (in our patient 2 x 3 cm) firmly attached to the skin . Since the incidence of local metastases is variable, the patient who presents with poorly differentiated prostatic carcinoma after perineal needle biopsy should be carefully monitored especially one month up to one year after the initial diagnosis . In our case, the appearance of the perineal metastatic nodule only one month after biopsy was accompanied by a worsening of the patient's condition and hence, may represent a poor prognosis . We believe the best treatment for this type of cancer recurrence is radical excision of the mass . However, if margins of enucleation are not free of tumor, then radical excision with so-
64
pervoltage radiation to the perineum should be the mode of therapy. We still feel that the perineal needle biopsy is the best method for histologic diagnosis since the incidence of metastatic seeding is low, even though, in our case, it led to perineal localization of the cancer. Via Tonelli 16 41012 Carpi (MO) Italy References 1 . Blackard CE, Soucheray JA, and Gleason DF : Prostatic needle biopsy with perineal extension of adenocarcinoma, J Urol 106 :401 (1971) . 2 . Desai SG, and Woodruff LM : Carcinoma of prostate : local extension following perineal needle biopsy, Urology 3 : 87 (1974) . 3 . Kaufman JJ, and Schultz JI : Needle biopsy of the prostate : a reevaluation, J Urol 87 : 164 (1962) . 4 . Clark BG, Lcadbetter WF, and Campbell JS : Implantation of the prostate in site of needle biopsy : report of a case, ibid 70 : 937 (1953) . 5 . Goldman EJ, and Samellas W: Local extension of carcinoma of the prostate following needle biopsy, ibid 84 : 575 (1960) . 6 . Labardini MM, and Nesbit EM : Perineal extension of adenocarcinoma of the prostate gland after punch biopsy, ibid 97 : 891 (1967) . 7 . Fortunoff S : Needle biopsy of prostate, a review of 346 biopsies, ibid 87 : 159 (1962) .
UROLOGY
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JANUARY 1986
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VOLUME XXVII, NUMBER 1