HISTORY:

A 37-year-old male patient seeking management for a pelvic mass involving the seminal vesicles and prostate presented to The OSU for a three-year duration of intermittent, painless, gross hematuria accompanied by initial episodes of hemato-spermia prompted a CT urogram investigation indicating a 7.2 cm lobulated ill-defined mass arising from the seminal vesicles. Persistent mass was identified on CT pelvis following a two-week treatment regimen of Levaquin and Prednisone. The patient ultimately underwent a robotic cystoprostatectomy after progressive severity of hematuria and urinary incontinence.

On gross examination of the pelvic mass (prostate, seminal vesicles, and bladder), a large nodular mass causing distortion of the prostate gland was seen. Opening of the specimen revealed a 9.2 x 7.1 x 7.5 cm diffusely cystic, diffusely necrotic mass appearing to arise from the right half of the prostate.  The mass appeared to border upon the distal urethral/prostatic apex margin, extending to the bladder mucosa and muscularis on the right lateral bladder wall, though not into the peri-vesicular fat.  The remainder of the bladder mucosa was gray-brown and slightly edematous with no additional lesions.  The mass bordered the inked outer surface on both the right anterior lateral and posterior aspects of the bladder.  It also appeared to involve the right seminal vesicle, abutting, though not grossly involving the right vas deferens.  The mass remained 0.7 cm from the posterior inked outer surface of the bladder.  Sectioning through the uninvolved prostate revealed pale tan-pink, diffusely fibrotic cut surfaces.  There was no uninvolved prostate gland or seminal vesicle identified in the right half. No palpable lymph nodes were identified in the peri-vesicular fat.

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