Case Study

Prostatic carcinoma diagnosed by FNA in a 14 year old MN Papillon

A 14-year-old MN Papillon with history of calcium oxalate uroliths and currently on urinary S/O diet was presented for hematuria, stranguria, and dysuria. Trace hematuria and leukocyturia was evident on urinalysis. Physical examination was within normal limits. Abnormalities on CBC and blood chemistry were hemoconcentration, neutropenia, lymphocytosis, elevated CK. T-4 was within normal range. The patient was treated with Zeniquin.

DX

Prostatic carcinoma, likely transitional cell carcinoma.

Sonographic Differential Diagnosis

Urinary bladder polypoid masses. Mineralizing prostatic mass. The minor renal changes are most consistent with pyelonephritis yet infiltrative disease could not be entirely ruled out without biopsy. Chronic scarring and fibrous retraction or history of calculi passage may also cause these changes.

Image Interpretation

The urinary bladder presented multiple polypoid masses that were non resectable with a 3.7 x 3.3 cm, mineralizing prostatic mass. It was highly suggestive for carcinoma with an abscess within the prostatic parenchyma. The kidneys presented ill-defined patchy hyperechoic cortical changes with nebulous corticomedullary definition and medullary debris. The renal pelvis was slightly dilated, hyperechoic and uniformly thickened with no evidence of ureter obstruction in either kidney. No overt masses were noted.

Outcome

The patient was treated with Clavamox and Deramaxx

Comments

Assessment of urinalysis for protein, WBC, RBC and bacterial counts are warranted as well as culture and sensitivity. No video is available on this patient.

Clinical Differential Diagnosis

Urinary signs – bladder pathology (bacterial cystitis, neoplasia, uroliths), urethral pathology (neoplasia, urolith, stricture), prostatic disease (neoplasia, prostatitis).

Sampling

The prostatic abscess was drained, and fine-needle aspirates were performed of the prostatic parenchyma. Cytology revealed carcinoma, compatible with a transitional cell carcinoma.