|Year : 2004 | Volume
| Issue : 2 | Page : 186-187
Carcinoma of the prostate presenting as IVC obstruction
Maneesh Sinha, Nitin S Kekre, Ganesh Gopalakrishnan
Department of Urology, Christian Medical College and Hospital, Vellore, India
Department of Urology, Christian Medical College and Hospital, Vellore - 632 004
Source of Support: None, Conflict of Interest: None
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
| Case Report|| |
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|| |
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.  Kassimis reported 2 cases with carcinoma of the prostate who developed IVC obstruction on chemotherapy and diethylstilbesterol respectively.  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.  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|| |
|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. |
|2.||Kassimis BS. Spiers AS. Inferior vena cava obstruction. A complication of prostate cancer. Arch Intern Med 1979: 139(9): 1056-7. |
|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. |
[Figure - 1], [Figure - 2]