References
Curran, F. T., Kasthuri, N. and Young, C. H. (1987). Carcinoma of the urachus. Br. J. Hosp. Med., 38, 463.
Fitzgerald, E. J. and Pirani, M. (1985). Computed tomography and ultrasound of a urachal cancer. Br. J. Radiol., 58, 88-90.
Sheldon, C. A., Clayman, R. V., Gonzalez, R. et al. (1984). Malignant urachal lesions. J. Urol., 131, 1-8.
Requests for reprints to: K. J. Ng, Department of Surgery, Victoria Infirmary, Glasgow G42 9TY.
Arteriovenous Malformation of the Spermatic Cord
B. OKTAY, M. ÖZYURT, O. EROL and U. ŞIMŞEK, Department of Urology, University of Uludag School of Medicine, Bursa, Turkey
A hard, irregular scrotal mass is an indication for surgical intervention because of malignancy. These masses include germ cell tumours, paratesticular tumours, fibromas and chronic epididymitis. We present the second reported case of an arteriovenous malformation of the spermatic cord presenting as a hard scrotal mass. The first case was reported by Guz et al. (1989).
Case Report
A 27-year-old man presented with a 4-week history of an asymptomatic scrotal mass. There was no history of
trauma or infection. The mass was separate from his testes and did not transilluminate.
Scrotal exploration revealed a mass containing blood- like fluid (Fig.) but it did not appear malignant. The testis and epididymis were normal. The mass was excised and histological examination revealed arteriovenous malformation.
This benign lesion should be included in the differential diagnosis of paratesticular masses.
Reference
Guz, V. B., Ziegelbaum, M. and Pontes, E. (1989). Arteriovenous malformation of spermatic cord. Urology, 23, 427.
Requests for reprints to: B. Oktay, Department of Urology, University of Uludag School of Medicine, Bursa, Turkey.
Tumour-to-tumour Metastasis: Bladder Carcinoma Metastasising to an Adrenocortical Adenoma
R. F. T. McMAHON, Department of Pathological Sciences, University of Manchester, Manchester
Case Report
An 81-year-old woman was admitted to hospital for investigation of recent confusion. Examination revealed a disorientated woman without localising physical signs. She was hypercalcaemic (3.28 mmol/l) and in chronic renal failure (urea 15.8 mmol/l; creatinine clearance 26 ml/min). Intravenous urography showed a non-func-
CASE REPORTS
tioning left kidney. A urinary infec ion (Proteus mirabilis) was treated with antibiotics. Mi hramycin was given intravenously to lower the serum calcium. Her general condition deteriorated gradually ur til death 25 days after admission.
At autopsy there was dilatatior of the bladder with ulceration and thickening of the left lateral wall. The left ureteric orifice was obstructed by irregular firm white tumour, 3.5 cm in maximum diameter, with resultant hydroureter and hydronephrosis. A well circumscribed yellow nodule 1.5 cm in diameter was present in the right adrenal gland. Metastatic tumour was found in abdominal lymph nodes, liver, pleura and heart.
Histological examination showed a poorly differen- tiated transitional cell carcinoma. The adrenal cortex contained an encapsulated tumour composed of large clear cells within which discrete clusters of malignant cells were present, identical to the primary bladder carcinoma (Fig.).
Comment
Bladder carcinoma is responsible for 3% of deaths from malignant disease, metastasising late in its course to lymph nodes, lung, liver and bone and in 5 to 12% of cases to adrenal glands (Fetter et al., 1959). Adrenocortical adenomas are found in 2% of all autopsies. They are rarely identified as recipient tumours for metastatic carcinomas and were initially reported by Ortega et al. (1951) as a site for deposition of bronchogenic carcinoma.
Fig Adrenocortical adenoma, containing large clear cells, within which 2 nests of pleomorph c metastatic bladder carcinoma cells can be seen. (H & E x 320).
Most of the subsequent reports of donor neoplasms to adrenal adenomas have been of lung cancers but breast, kidney, colon, stomach and thyroid primar- ies have also been described (Scierski and Podwor- ski, 1973). This is believed to be the first case of bladder carcinoma metastatic to an adrenocortical adenoma and, indeed, the first time that bladder carcinoma has been recognised as a component of a neoplasm-to-neoplasm metastasis, either as donor or recipient.
Acknowledgements
I thank Dr J. T. Leeming for permission to present clinical details of his patient and Dr E. W. Benbow for helpful discussion on the histopathology of this case.
References
Fetter, T. R., Bogaev, J. H., McCuskey, B. et al. (1959). Carcinoma of the bladder- sites of metastases. J. Urol., 81, 746-748.
Ortega, P., Li, I. Y. and Shimkin, M. (1951). Metastasis of neoplasms to other neoplasms. Ann. West. Med. Surg., 5, 601- 609.
Scierski, A. and Podworski, H. (1973). Metastasis of the breast carcinoma to adrenocortical adenoma. Arch. Geschwultforsch., 42, 240-243.
Requests for reprints to: R. F. T. McMahon, Department of Pathological Sciences, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT.
Small Cell Carcinoma of the Prostate: Implications for Management
F. ADSHEAD, A. DE GRAEFF, J. L. MANSI, D. M. THOMAS and I.E. SMITH, Departments of Medicine and Histopathology, Royal Marsden Hospital, London
A patient with known adenocarcinoma of the prostate presented 5 years after his initial diagnosis with liver metastases and Cushing’s syndrome due to ectopic adrenocorticotrophic hormone (ACTH). He was treated with high dose aminoglutethimide and chemotherapy but died 2 months later after an initial response. Autopsy confirmed a small cell component within the liver and bone. There is evidence that chemotherapy is effective in these patients and should be considered as the treatment of first choice.