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JAMA Surgery Clinical Challenge
July 2014

Pelvic Mass After Prostatectomy

Author Affiliations
  • 1Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla
  • 2Division of Surgical Pathology, Department of Pathology, University of California, San Diego, La Jolla
  • 3Division of Urology, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla
  • 4Division of Medical Oncology, Department of Medicine, Moores Cancer Center, University of California, San Diego, La Jolla
JAMA Surg. 2014;149(7):741-742. doi:10.1001/jamasurg.2013.3948

A 66-year-old man was doing well 6 months after robotic radical prostatectomy for prostatic carcinoma and synchronous left radical nephrectomy for renal cell carcinoma. However, on surveillance computed tomography, he was noted to have a new pelvic mass that was concerning for a recurrent malignant neoplasm. He denied having pelvic pain, urinary symptoms, or bowel symptoms. His prostate-specific antigen level was undetectable. Subsequent magnetic resonance imaging revealed a heterogeneously enhancing mass within the prostatic bed, which had central necrosis (Figure). The mass measured 4.8 × 5.5 × 5.0 cm and was contiguous with the right obturator internus. No appreciable lymphadenopathy was noted. Computed tomography–guided biopsy revealed spindle cells with a low mitotic index. Of note, the patient’s son has a history of neurofibromatosis 1. The result of immunohistochemical staining was diffusely positive for desmin and smooth muscle actin, as well as focally positive for pan-keratin and S100. The staining result was negative for CD34 and CDK4. Fluorescence in situ hybridization failed to demonstrate MDM2 (OMIM 164785) gene amplification.

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