攝護腺血腫: 攝護腺癌罕見呈現方式 – 病例報告
陳世亮、張廷瑞、許智凱
台南市立醫院 泌尿科
Prostatic hematoma: an unusual presentation of prostatic cancer – A case report
Shih-Liang Chen, Ting-Jui Chang, Chih-Kai Hsu
Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan
Background: Large hypodense mass in the prostate may be due to infection, abscess, cyst, hematoma, BPH or neoplasm. Prostatic bleeding is an uncommon complication of prostatic cancer, usually occurring in advanced stages of disease. Every case of prostatic collection must be considered with attention, and further evaluation is necessary. Here we report the case of a prostatic hematoma, an unusual presentation of prostate cancer.
Case Report: A 72 years-old male patient complained for nocturia (3-4 times/night), frequency, and voiding difficulty with small caliber for years. Prostate sonography was arranged and showed 46ml with large hypodense mass at left lateral lobe. A CT scan of the pelvis showed prostate enlargement with left lateral lobe hypodensity, highly suggestive of blood collection. PSA was checked and showed fluctuation 538ng/ml, 326ng/ml and 131ng/ml. Transrectal ultrasound guide aspiration was arrange and revealed hemorrhagic fluid collection; and biopsy reported prostate adenocarcinoma; Gleason Score: 3+4=7. After performed palliative TUR-P; HIFU was arranged 3 months later for cancer management. The follow up PSA reported 0.561ng/ml.
Discussion: The differential diagnosis of large prostatic collection includes prostatic abscess, traumatic prostatic hematoma, spontaneous prostatic hematoma, prostatic infarction, complicated prostatic cyst and complicated prostatic cancer. US and CT scans were useful in defining the presence of hematoma, but the etiologic diagnosis remained challenging. When prostatic cancer is a concern, tissue diagnosis is necessary. The role of needle biopsy is important to obtain tissue for pathologic proved. In selected cases transurethral drainage can be useful. After clinical stabilization and histopathological diagnosis, further cancer treatment can be planned, depending on tumor stage,
grade, patient’s will, age and life expectancy.