Reply of Dr. Chen

Those of us who were practicing urology in the 1940s and 1950s can remember that epididymitis was a serious postoperative complication which was not only painful and disabling but occasionally was followed by the formation of an abscess which involved both the epididymis and the testis. The antibiotics which we presently have are far more effective against epididymitis than those which we possessed thirty years ago. As a result, vasectomy has become unfashionable in connection with prostatectomy. Properly done it will prevent almost every case of postoperative epididymitis. Any exceptions can be blamed on infection reaching the epididymis before the vasectomy was done or a recanalization of the vas deferens after a poorly performed vasectomy. S. Schmidt, M.D. 707 K Street Eureka, California 95501

2), further confirmed by demonstration of positive staining of the tumor cells by prostatic acid phosphatase. We have seen quite a few cases of wellcircumscribed Gleason’s pattern 1 or 2 adenocarcinemas while we studied 143 incidental prostatic cancers’ as well as 130 cancers of prostate with negative metastatic diagnostic studies.* I think that the lesion described in the article has all the features of adenocarcinoma, therefore a diagnosis of “adenomatoid tumor” does not seem to be justified.

Louisiana

References

Stanwood

References 1. Crabtree EG, and Brodny ML: Vasectomy in prostatic surgery; review of 141 consecutive prostatectomies, Trans Am Assoc Genitourin Surg 23: 383 (1930). 2. Kreutzmann HAR: Symposium on pyogenic prostatitis; studies of infections of vas deferens, J Urol 39: 123 (1938). 3. Abeshouse BS, and Lerman S: Vasectomy in the prevention of epididymitis following prostatic surgery, Urol Cutan Rev 54: 385 (1950). 4. Rolnick HC: Regeneration of vas deferens, Arch Surg 9: 188 (1924).

ADENOMATOID

PROSTATIC

TUMOR

To the Editor: In the January issue (vol. 21, pages 88-89) of UROLOGY, K. T. K. Chen and J. J. Schiff describe a circumscribed nonencapsulated nodule in a hyperplastic prostate. Their microscopic description of the lesion as well as the representative illustrations clearly show that the nodule is a welldifferentiated adenocarcinoma (Gleason’s pattern

Deba P. Sarma, M.D. Department of Pathology State University Medical Center New Orleans, Louisiana 70112

1. Guileyardo JM, et al: Incidental prostatic carcinoma: tumor extent versus histologic grade, Urology 20: 40 (1982). 2. Thomas R, et al: Aid to accurate clinical staging, histopathologic grading in prostatic cancer, J Ural 128: 726 (1982).

Reply of Dr. Chen To the Editor: The diagnosis of welldifferentiated adenocarcinoma, as suggested by Dr. Sarma, was seriously considered in the initial evaluation of this case. However, the absence of macronucleoli, and the arborizing branching pattern argue against this diagnosis. In my experience, all prostatic carcinomas demonstrate macronucleoli at least in focal areas if serial sections are examined. The arborizing branching pattern of the gland-like spaces has not been reported in prostatic carcinomas.

Fresno Community

Karl T. K. Chen, M.D. Department of Pathology Hospital and Medical Center Fresno,

UROLOGY

/ APRIL 1983

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VOLUME

California

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