CWM Hospital Fiji School of Medicine Depts' of Medicine

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CWM Hospital / Fiji School of Medicine Depts. of
Medicine Pathology
CPC Meeting 23/8/2001

• Ca Prostate with Filariasis

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Presenting sympton

• A 74 year old man presented with a three month
  history of weakness and tiredness
• For the past month he was also seen to have
  haematuria.
• He was admitted to a district hospital and after
  two weeks was found to be in urinary retention
• He was treated with a catheter, but transferred
  when his urinary output fell and he became
  increasingly breathless.

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Past history.

• 2 prostate operations in the past ? For what
  reason

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On examination

• Blocked catheter noted irrigated and developed
  haematuria.
• Patient unable to move legs (on further
  questioning he has been paraplegic for 1 month)
• Pallor noted
• Rectal exam hard lumpy prostate.

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Clinical diagnosis

• 1. Prostate Ca.
• 2. Spinal cord compression secondary to bony
  metastases
• 3. Anemia secondary to ? Renal failure and
  haematuria
• 4. CCF secondary to fluid overload and anemia.

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Investigations

• Creatiine 407
• Hb 5.7
• X-rays to follow

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X-rays of pelvis and spine
Multiple lytic lesions
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Destruction of disc and ? vertebral collapse
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Treatment

• He was booked for trans-urethral resection of the
  prostate and bilateral orchidectomy.
• Samples of prostatic tissue and testicular tissue
  were sent for pathology

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TURP-Prostate Biopsy
Normal Prostatic glands
Stroma
Tumor tissue
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TURP-Prostate Biopsy
Normal Prostatic glands
Stroma
Tumor tissue
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TURP-Prostate Biopsy
Normal Prostatic glands
Stroma
Tumor tissue
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TURP-Prostatic Carcinoma
High power view showing Tumor tissue Forming
glands
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TURP-Prostatic Carcinoma
Tumor embolism in a dilated lymphatic vessel.
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Orchidectomy - Testes biopsy
Atrophic semineferous tubules
Inflammatory tissue
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Orchidectomy - Filariasis
Filarial worm in the center
Inflammatory tissue
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Orchidectomy - Filariasis
Cutsection of worm Intense Eosinophilic
inflammatory reaction.
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Orchidectomy - Filariasis
Filarial worm in the center
Inflammatory tissue with plenty of Eosinophils
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Orchidectomy - Filariasis
Giant cells Scavenger cells
Filarial worm undergoing necrosis
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Orchidectomy - Filariasis
Late stage may show only few Giant cells and no
worm.
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Diagnosis

• 1. Metastatic carcinoma of the prostate
• 2. Filiariasis diagnosed incidentally

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Filariasis

• Caused by nematode Wuchereria bancrofti
• Rarely by Brugia malayi (10)
• Causes asymptomatic microfilaremia to
• Chronic lymphadenitis with swelling of dependent
  organ Elephantiasis.
• Also causes tropical pulmonary eosinophilia
• Larva Transmitted by mosquitoes develop in
  lymphatic channels into adults.

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Filariasis

• Cause eosinophilic inflammatory reaction.
• Persistent lymphangitis and lymphedema of
  scrotum, penis, vulva, leg, arm.
• Enlargement of organ and thickening of skin -
  elephantiasis.
• Adult worms live, dead or calcified remain in
  lymphatics surrounded by inflammation.