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CASE REPORT
Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 186-187
 

Carcinoma of the prostate presenting as IVC obstruction


Department of Urology, Christian Medical College and Hospital, Vellore, India

Correspondence Address:
Ganesh Gopalakrishnan
Department of Urology, Christian Medical College and Hospital, Vellore - 632 004
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Inferior vena cava, obstruction, carcinoma prostate


How to cite this article:
Sinha M, Kekre NS, Gopalakrishnan G. Carcinoma of the prostate presenting as IVC obstruction. Indian J Urol 2004;20:186-7

How to cite this URL:
Sinha M, Kekre NS, Gopalakrishnan G. Carcinoma of the prostate presenting as IVC obstruction. Indian J Urol [serial online] 2004 [cited 2019 Jun 18];20:186-7. Available from: http://www.indianjurol.com/text.asp?2004/20/2/186/20763



   Case Report Top


A 67-year-old diabetic gentleman presented with a ab­dominal computed tomography (CT) scan done elsewhere for bilateral asymmetrical pedal edema of 3 months dura­tion. It showed a mildly enhancing mass situated in the right lower paracaval region. The mass was seen to en­case the lower part of the inferior vena cava (IVC). Right moderate hydroureteronephrosis was noted with the ure­ter involved within the paracaval mass. Another well-de­fined mass was noted at the left renal hilum lying just in­ferior to the renal vein [Figure - 1].

The patient was otherwise asymptomatic. Physical ex­amination confirmed the pedal oedema which was more on the right than the left. Digital rectal examination was suspicious of prostatic malignancy. His serum prostate spe­cific antigen (PSA) was 41 ng/ml. Transrectal ultrasound was reported as an isoechoic symmetrical prostate. Sex­tant biopsies revealed prostatic adenocarcinoma of Gleason grade 4. CT guided biopsy of the para aortic mass was carried out considering the rarity of vena cava obstruction in prostatic adenocarcinoma. It was reported as small cell carcinoma. Although the pathologist had a doubt of carci­noma of the prostate it could not be confirmed with im­munohistochemical staining as the available tissue was inadequate.

Bilateral orchidectomy was done and the patient was reviewed after 3 months. There was a considerable im­provement in limb edema. A repeat abdominal CT scan showed complete resolution of the retroperitoneal mass. The right kidney showed no evidence of hydronephrosis [Figure - 2]. His repeat PSA was 0.4 ng/ml.


   Comments Top


A search of the English literature revealed 4 cases of IVC obstruction resulting from carcinoma of the prostate. Siqueira-Filho mentioned one case in a review of 64 pa­tients of IVC obstruction but gave no details. [1] Kassimis reported 2 cases with carcinoma of the prostate who de­veloped IVC obstruction on chemotherapy and diethylstil­besterol respectively. [2] In 1986, Benderev ereported a patient diagnosed to have metastatic adenocarcinoma of the prostate who refused orchiectomy and returned 3 years later with IVC obstruction. [3] The obstruction resolved af­ter orchiectomy. In our patient similarly, the IVC obstruc­tion resolved with orchiectomy without recourse to anticoagulants. To our knowledge this is the first reported case where features of IVC obstruction on presentation led to a diagnosis of prostatic carcinoma.

 
   References Top

1.Siqueira-Filho AG. Kottke BA, Miller WE. Primary inferior vena cava thrombosis: report of 9 cases. Arch Intern Med 1976; 136(7): 799-802.  Back to cited text no. 1    
2.Kassimis BS. Spiers AS. Inferior vena cava obstruction. A compli­cation of prostate cancer. Arch Intern Med 1979: 139(9): 1056-7.  Back to cited text no. 2    
3.Benderev TV, Grayhack JJ, Bockrath JM, Uke ET. IVC obstruc­tion secondary to adenocarcinoma of the prostate. Role of orchiec­tomy in treatment. Arch Intern Med 1986; 146(3): 598-9.  Back to cited text no. 3    


    Figures

  [Figure - 1], [Figure - 2]



 

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