11 year old, MN (I need to check date of castration, but likely when young). History of chronic hematuria, stranguria, tenesmus and small feces. Weigh loss and apathy. UA: calcium oxalate crystals.
-Prostate area has what it appears like a cystic structure with calculi. No much (mild) regional inflammation. Medial iliac Lns WNL. kidneys quite WNL (small mineralized focci-1 small 0.17cm calculus; mild hypoechoic outer cortex-hyperechoic medullary band). Left adrenal plump 0.7cr pole, 0.57 cd pole. Spleen Liver normal.
11 year old, MN (I need to check date of castration, but likely when young). History of chronic hematuria, stranguria, tenesmus and small feces. Weigh loss and apathy. UA: calcium oxalate crystals.
-Prostate area has what it appears like a cystic structure with calculi. No much (mild) regional inflammation. Medial iliac Lns WNL. kidneys quite WNL (small mineralized focci-1 small 0.17cm calculus; mild hypoechoic outer cortex-hyperechoic medullary band). Left adrenal plump 0.7cr pole, 0.57 cd pole. Spleen Liver normal.
-What differentials would be for prostate in a neutered patient other than neoplasia? It appears low vascularized. Abscess? paraprostatic cyst? what can we do with those intraprostatic stones?
thanks for your input.
Comments
Carcinoma is surely first on
Carcinoma is surely first on the list but if you look closely here the mineralization is in line wiht the urethra and playign cup half full I can imagine a mural abscess or prostate abscess and reguinal tissue hypertrophy form chronic stone issues which yorkies have. This is especially visible in my imaginoscope of video 2… urethral stones and then some echoes in the wall of the cyst.
So what I would do is drain the cyst, aerobic and anaerobic culture all us guided and once drained fna the accessible tissue or do a traumatic catheterization (http://sonopath.com/resources/interventional-procedures) but I would play the 50/50 card with the owner on neoplasia/vs inflammatory here until you have a slide that says carcinoma. Stone movers do strange things chronically with their lower urinary tract and u-paps.