ALBERTO G. AYALA
MD Anderson Cancer Center
This is a 52 year-old man who presents with urinary obstruction, a soft and enlarged prostate at
palpation, no localizing ultrasound lesions and a PSA of 11.79. Eight core biopsies are done.
Wellington School of Medicine
Wellington South, New Zealand
A 48 year old male was referred to a specialist surgical centre with a provisional diagnosis of
pseudomyxoma peritonei. In the last five to six years he had noted a steady increase in abdominal
girth and this had become particularly pronounced over the preceding six months. During this time he
had also noted a loss of abdominal muscle bulk. He reported no difficulty with micturation or bowel
Examination on admission confirmed marked abdominal distension. Computerised tomography
showed a large multicystic mass almost entirely confined to the infracolic compartment, however,
somewhat atypical for pseudomyxoma peritonei was the lack of extensive involvement in the
subdiaphragmatic space and spleen. The patient went forward to laparotomy and a large cystic mass
involving the rectosigmoid and prostate was found. The tumor was removed in two stages with resection
of an extensive mass measuring 37 x 31 x 13 cm. Residual tumor was noted to be adherent to the rectum
and bladder, and there was an attachment to the left posterior-lateral surface of the prostate. In
the second stage procedure the bladder and prostate were removed en bloc with all residual tumor.
Wiell Medical College of Cornell University
New York, NY
A 68-year old female on hemodialysis for chronic renal failure, was found to have a 4 cm solid mass in
her left kidney. Left simple nephrectomy was performed.
JOHN C. CHEVILLE
Mayo Medical School
A 65-year-old male presented to his urologist with hematuria. During the physical examination, a
nodule was palpated on the right side of his prostate. His serum PSA was 3.8 ng/ml. A prostate
needle biopsy procedure was performed followed by a radical cystoprostatectomy. Images 1-4 are taken
from the prostate needle biopsy specimen; Images 5,6 are taken from the prostate resection specimen.
SHARON W. WEISS
Emory University School of Medicine
The patient is a 48-year-old male with a history of NF1 who presented with a nodular lesion of the
bladder which was incompletely excised. Over a period of 3 months 3 additional surgeries were
necessary to control disease. Finally because of progressive symptoms the urologist elected to
perform a total cystectomy. The specimen revealed an ulcerating lesion which extended through the
bladder wall into perivesical fat. The patient died two years later of complications of NF1 but was
not noted to have evidence of the recurrent bladder tumor.