TUMORS OF THE PROSTATE.
As the prostate is composed of fibrous, muscular (unstriated), and epithelium-lined gland tissue, we may expect to meet with connective tissue tumors, myoma, adenoma, and carcinoma, and these we find to be the new growths of this part.
Myoma.—Unstriated muscular tumors of the prostate are met with as small encapsulated growths, most frequent in the so-called middle lobe, or as large masses apparently involving the whole part. Such a case was Mr. Spanton's," where a mass of growth the size of a fist was removed by operation, and a further equally large mass was found at the autopsy. It closely resembled that of a moderately soft uterine myoma, and in this connection the developmental identity of the female uterus with the male sinus pocularis and its immediately sur rounding muscular fibre is to be noted. Pure myoma of the prostate is a rare growth. The encapsuled tumors usually contain a consider able admixture of glandular tissue, and are properly called adeno myoma. They correspond to the adeno-fibroma so frequently met with in the female breast.
Sarcoma of the prostate would appear to be the form of new growth most frequently met with in this part. In structure it may be round- or spindle-celled, or, as is frequently the case in the blad der, a lympho-sarcoma.
Carcinoma of the prostate is either tubular or acinous, and, in either case, may become colloid. Sections of it show a stroma com posed mainly of unstriated muscular fibre, containing alveoli filled with cells resembling those of the prostatic glands.
Primary carcinoma of the prostate is not of such rare occurrence as is generally supposed. It is frequently overlooked, both during life and after death, any enlargement or induration being regarded as merely ordinary hypertrophy. In several instances which I have seen, where the diagnosis was verified by microscopical examination, the disease was marked by slow progress and by the slightness of the local symptoms that were present throughout. It appeared to prove fatal by the general decay that was induced, rather than by any interfer ence it occasioned, directly or indirectly, with the function of mictu rition, thins contrasting with advancing forms of ordinary prostatic hypertrophy. The following case seems to illustrate this : CASE. -I frequently saw a gentleman, aged 59, in 1884, who sufCase i-I frequently saw a gentleman, aged 59, in 1884, who suf- fered from irritability of the bladder, which he could not completely empty. He was losing flesh, becoming pale, and, though the mental faculties remained vigorous to the last, he constantly complained of pain in the loins, nates, and thighs. In the course of a few weeks he became entirely dependent upon the catheter. His prostate was hard, nodular, and almost insensitive to the touch, though no glands in the neighborhood were involved. As his general health slowly declined,
minute petechial spots appeared on various parts of his body, and his feebleness gradually increased. Occasionally he passed a small quantity of blood with his urine. He appeared to die of exhaustion, the result of prolonged blood-vitiation. After death his prostate was examined and found to be an unmistakable example of carcinoma. There was no evidence to show that this was other than the primary disease. • Mr. Bryant " has recorded a case of fibrous polypus of the prostatic portion of the urethra, associated with profuse hmmaturia and pros tatic enlargement, where, on exploration by a median perineal opera tion, a polypus the size of a haricot bean was removed. After a some what tedious convalescnce recovery ensued, and eighteen months after the operation the patient was well, with his prostate contracted to its original size.
The prostate is frequently the seat of small calcareous deposits, which have been described under the name of prostatic calculi. They probably represent a concreted state of the natural secretion of the prostatic glands.
Tubercle of the prostate, which is first miliary and then caseous, may he mistaken for new growth if care he not taken to exclude it on clinical grounds. It is, as a rule, secondary to tubercle of the kidney and bladder or of the testicle, most frequently the latter. Prostatic cysts may be either retention cysts of the nrostatic follicles, or, what is more usual, urethral diverticula, as in a case recorded by Mr. W.
Arbuthnot Lane." Some growths involving the urethra have been already referred to in connection with malignant or cancerous strictures. Polypi of an innocent kind are sometimes met with in this position. Mr. W. H.
Brown records an instance which is unique: CASE.—The patient, a male, aged 18, was under observation dur ing 1891, for difficult and painful micturiti on. The pain was referred to the end of the penis, and there was frequent incon tinence at night and drib bling of the urine when walking about. On one occasion, whilst straining to urinate, about two ounces of bright blood were expelled. On his attempting to pass urine the stream was very small, and a curious bal loon-shaped swelling just over the urethra at the junction of the penis with the scrotum was observed. The urine was natural. The boy died of extensive cystic disease of the kid neys. The growth in appearance resembled a polypus and was attached behind to the prostatic re gion in the posterior wall of the bladder, and in front to the urethra as shown in the drawing (Fig. 45). Mr. Brown observes : " I have not been able to find a similar record. The posi tion of the tumor and its twofold attachment are, so far as I know, without parallel."