案例報告 – 意外初診斷攝護腺癌於腹股溝疝氣囊
鍾尚融1、賴昱維1,4、薛又仁1,4、蕭毅君1、黃建榮1、邱文祥1,4、楊明叡2、吳毅穎3
1台北市立聯合醫院仁愛院區外科部泌尿科，
2臺北市立聯合醫院仁愛院區外科部一般外科
3台北市立聯合醫院仁愛院區病理科
4國立陽明大學醫學院醫學系泌尿學科
Incidentally found metastatic adenocarcinoma of prostate in an incised inguinal hernia sac
Shang-Rong Zhong1, Yu-Wei Lai1,4, Thomas Y. Hsueh1,4, Yi-Jiun Hsiao1,4, Andy C. Huang1,4, Allen W. Chiu1,4, Ming-Jui Yang2, Yih-Yiing Wu3
1Division of Urology, Department of Surgery, Taipei City Hospital renai branch, Taipei, Taiwan 2Division of General Surgery, Department of Surgery, Taipei City Hospital renai branch, Taipei, Taiwan
3Department of Pathology, Taipei City Hospital renai branch, Taipei, Taiwan
4Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Introduction: Prostate cancer with inguinal hernia sac metastasis is a rare event. Herein we report a rare case of prostate cancer with inguinal hernia metastasis.
Case report: An 83-year-old male patient received hernioplasty and the submitted specimen was incidentally found to have adenocarcinoma of prostatic microscopically. The patient had undergone transurethral resection of prostate for three times in the latest 10 years. Benign pathological results were found in all three transurethral resection of prostate. The patient received serum PSA checkup while PSA level was 40.37 ng/ml. He received trans-rectal ultrasound-guided prostate biopsy and prostate adenocarcinoma with Gleason score 4+5 was noted.
Discussion: Inguinal hernia sacs obtained from hernioplasty are routinely sent for pathological examination in some medical facilities although meaningful results are rare. A retrospective study released in 2014 presented only 11 cases (0.35%) of malignancy in a total of 3117 specimens while one third of patients had preexisting malignancies before operations. There were only sporadic case reports on the prostate cancer disclosed in hernia sacs, while nearly all cases displayed metastasis found in the inguinal hernia sac. These findings suggested advanced nature of the disease and a diminished survival time. This report reminds us of the polymorphic characteristics of the prostate cancer and its possibility of metastasis in an unusual way.