The Journal of Spinal Cord Medicine
ISSN: 1079-0268 (Print) 2045-7723 (Online) Journal homepage: http://www.tandfonline.com/loi/yscm20
T-cell Lymphocytic Lymphoma Involving the Prostate Presenting as Elevated PSA in Paraplegia: Case Report Tracy R. Johnson, Douglas B. Barber, Joel M.H. Teichman & Antoinne C. Able To cite this article: Tracy R. Johnson, Douglas B. Barber, Joel M.H. Teichman & Antoinne C. Able (1996) T-cell Lymphocytic Lymphoma Involving the Prostate Presenting as Elevated PSA in Paraplegia: Case Report, The Journal of Spinal Cord Medicine, 19:4, 258-260, DOI: 10.1080/10790268.1996.11719443 To link to this article: http://dx.doi.org/10.1080/10790268.1996.11719443
Published online: 10 May 2016.
Submit your article to this journal
View related articles
Citing articles: 5 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yscm20 Download by: [Australian Catholic University]
Date: 19 August 2017, At: 12:42
T-cell Lympho cytic Lympho ma Involvin g the Prostate Presenti ng as Elevated PSA in Parapleg ia: Case Report 1 Tracy R. Johnson, M.D., Douglas B. Barber, M.D., 12 Antoinne C. Able, M.D. ·
12 ·
23 ·
Joel M.H. Teichman, M.D.,
Downloaded by [Australian Catholic University] at 12:42 19 August 2017
ABSTRACT
The vast majority of cancers that involve the prostate are adenocarcinomas of the duct-acinar secretory epithelium. Other cancers, primarily leukemia and lymphoma, can involve the prostate and lead to an abnormal digital examination or elevated serum prostate specific antigen (PSA) . The case discussed is that of a 62 year-old male with T12 complete with T-cell lymphoma ~araplegia who presented with a persistently elevated PSA and was subsequently diagnosed in the differential included be should prostate the involving l~volving the prostate. Although rare, leukemia and lymphoma 260) Med;19:258Cord Spinal (J prostate. the of oma adenocarcin for diagnosis of patients being evaluated Key words: prostate, lymphoma, paraplegia, prostate specific antigen (PSA) INTRODUCT ION
The vast majority of cancers that arise in the prostate are adenocarcin omas of the duct-acinar secretory epithelium. 1 Clinical suspicion of adenocarcin oma of the prostate commonly results when either an abnormal digital examinatio n or elevated serum prostate specific antigen (PSA), or both, is detected. The diagnosis of adenocarci noma is then confirmed via biopsy. Other cancers, primarily leukemia and lymphoma, can involve the prostate and lead to an abnormal digital examinatio n or elevated PSA. CASE REPORT
The patient, a 62 year old white male with T12 complete paraplegia secondary to a fall in 1989, presented in December, 1992, with a symptomat ic urinary tract infection (UTI). Previous videofluoroscopic urodynamic studies documented a low pressure, high capacity compliant bladder that was managed via clean intermitten t catheteriza tion (CIC). After completion of a seven day course of oral ciprofloxacin for the treatment of E . coli, repeat urinalysis (UA) and cul1
Department of Rehabilitation M edicine. University of Texas Health Science Center at San Antonio. Texas 2 Spinal Cord Injury SeNice. Audie L. Murphy Memorial Veteran s Hospital. San Antonio. Texas 3 Department of Surgery, University of Texas Health Science Center at San Antonio Correspondence: Douglas B. Barber. M.D. Chief. Spinal Cord Injury SeNice ( 1 28) Audie L. Murphy M emoria l Veterans Hospital 7 400 M erton Minter Boulevard San Antonio. TX 78284 Received M ay 2. 1996 Accepted: May 28, 1996
258
ture with sensitivity (C & S) confirmed eradication of the UTI but microscopic hematuria persisted. In addition, the patient reported the new onset of occasional difficulty in passing the catheter. An intravenou s urogram (IVU), cystoscopy and PSA assay were performed. The IVU was unremarkab le. Cystoscopy documented a stricture at the proximal bulb which was dilated without incident. The prostate was noted to be approximat ely 3.5 em in length with prominent lateral lobes. The PSA was elevated at 10.7 ng/ml (normal 0.2-4). The patient subsequently underwent transrectal ultrasound (TRUS) guided random biopsy of the prostate. The biopsies revealed stromal and glandular hyperplasia and chronic inflammati on without evidence of malignancy. Except for an E. coli UTI treated in October, 1993, the patient did well until May, 1994, when he experienced urethral trauma with his CIC program. Repeat PSA at that time noted continued elevation at 9.9 ng/ml. In July, 1994, repeat TRUS guided biopsy of the prostate was performed which demonstrat ed atypical cells consistent with high grade adenocarcinoma. Immunoper oxidase staining was negative for PSA, however, suggesting that the origin of the tumor might be urothelial or other than prostate. Computed tomography (CT) of the abdomen and pelvis showed marked inhomogen ous enhanceme nt and enlargement of the kidneys as well as enlargemen t of the pancreas, prostate and left rectus muscle. Within days after undergoing the CT, the patient complained of abdominal distension, band-like tightness at the T8 level restricting his breath and resulting in shortness of breath and worsening malaise. Physical examina-
Volume 19 Number 4
Downloaded by [Australian Catholic University] at 12:42 19 August 2017
tion was remarkable for left supraclavicular lymphadenopathy approximately 2x2 em in size and rubbery in consistency. Laboratory evaluation at that time was significant for a lymphocytosis; the white blood cell count (WBC) was 29.0 k/mm 3 (normal 4.810.8) with a differential of one percent neutrophils, four percent bands, 92 percent lymphocytes and three percent monocytes. He had a normal hemoglobin of 13.1 g/dl and hematocrit of 38.6 g/dl but thrombocytopenia was present with a platelet count of 45 k/mm 3 (normal 130-400). The patient was hypercalcemic with a serum calcium of 11.9 mg/dl (normal 8.5-10.5) and hyperuricemic with a uric acid of 18.6 mg/dl (normal3.9-9). In addition, liver function tests (LFTs) were elevated including lactate dehydrogenase (LDH) of 1146 U/1 (normall00-225), alkaline phosphatase of 240 (normal 30-115), SGOT of 59 U/1 (normal 8-40) and SGPT of 43 U/1 (normal 5-35). Amylase of 37 U/1 and lipase of 20 U/1 were normal. The patient was admitted with the presumptive diagnosis of lymphoproliferative disorder and received aggressive hydration and allopurinol with resolution of the hypercalcemia. Reexamination of the prostate biopsies with immunohistochemical stains for leukocyte common antigen (LCA) and aT-cell marker (9CD45RO) showed strong positivity in the infiltrating cells, confirming them to be oflymphoid (T-cell) origin (Figure 1). Flow cytometry of peripheral blood as well as bone marrow biopsy confirmed the diagnosis of lymphoblastic lymphoma, T-cortical thymocyte phenotype. The patient received chemotherapy including induction with HOP-1 (vincristine and doxorubicin), consolidation via the Linker regimen (VP-16 and AraC) and at the present time is receiving methotrexate and leucovorin. In addition, the patient received 2400 cGy of prophylactic radiation (XRT) to his calvarium and brainstem. Recent flow cytometry and bone marrow biopsy have revealed that the patient is in remission. In January 1996, the patient's PSA was noted to be 8.8 ng/ml. DISCUSSION
Malignant lymphoma involving the prostate, first described by Coupland in 1877, is a rare phenomenon. 2 Primary prostatic lymphoma without lymph node involvement appears to be particularly rare. Many authors questioned the existence of primary prostatic lymphoma until Fukase demonstrated the presence of lymphoid tissue in normal prostate. 3 In their series of 1467 cases of extranodal non-Hodgkin's lymphoma, ,
Figure 1. Invasion of prostatic stroma and glandu lar epithelium by T-ce ll lymphocytic lymphoma (dark cell s).
Freeman et al. 4 reported that only three (0.2 percent) were prostatic in origin. Rosenberg et al. 5 noted that only one in their series of 1,269 cases of lymphoma (0.08 percent) was of primary prostatic origin. Leukemia and lymphoma are the most common neoplasms reported to metastasize to the prostate. 6 In their series of 600 autopsy examinations of males with non-Hodgkin's lymphoma, Zein et al. 6 found only 49 cases (8.0 percent) with prostatic involvement and none were symptomatic. Other post-mortem studies have documented that approximately 10 percent of patients with non-Hodgkin's lymphoma have infiltration of some portion of the urinary tract, with less than one percent of the patients having urological symptoms.7,B Secondary infiltration of the prostate, although more common than lymphoma of primary prostatric origin, is still considered rare. As a result of the rarity of prostatic involvement by lymphoma, Smith and Dehner9 and Sridhar and Woodhouse 10 distinguished primary prostatic lymphoma from sec-
The Journal of Spinal Cord Medicine
259
Downloaded by [Australian Catholic University] at 12:42 19 August 2017
ondary prostat ic involve ment based upon the site of initial present ation, regardl ess of the presenc e of generalized lympho ma. Our compre hensive review of the literatu re revealed no previou sly reporte d cases of lympho ma of the prostat e occurri ng in a spinal cord injured patient . Able-bodied patient s with prostat ic lympho ma commonly present with sympto ms of urinary frequen cy and urgency and occasio nally with hematu ria and 11 acute urinary retentio n. In most patient s, the prostate was diffusel y enlarge d, nonten der and firm or rubbery on palpati on, similar to soft tissue sarcom as. There was usually no nodula rity but the median furrow was commo nly oblitera ted. System ic sympto ms, includi ng fever, chills, night sweats and weight loss 6 are observe d infrequ ently, and only in patient s with widesp read lympho ma. This appears to be the first report of prostat ic lympho ma diagnos ed as a result of pursuin g the etiology of an abnorm al PSA. The effect of infiltra tion of the prostat e by lympho ma on PSA levels has not been describ ed. We believe that the elevatio n in our patient represe nted a prostat itis that resulte d from the invasio n by lympho ma. Prostat itis is a conditio n 12 known to falsely elevate PSA. Lymph oma of the prostat e carries a poor prognosis, with few patient s survivi ng five years after the diagnos is. 13 The stage and bulk of disease at the time of diagnos is and the histologic classifi cation of the tumor are the two factors that most strongl y impact 14 the length of surviva l. Most recently , treatme nt of malign ant lympho ma of the prostat e has focused on chemot herapy and radiatio n therapy for treatme nt of systemi c disease and surgery for palliati on. Most authors agree that prostat ectomy is not effective in
260
prolong ing surviva l, althoug h it offers sympto matic 11 15 relief of urinary obstruc tion. •
REFERENCES 1. Stamey TA, McNeal JE. Adenocarcinoma of the prostate. In; Walsh PC, et al., eds. Campbell's urology. Philadelphia; W.B. Saunders Company, 1992:1159. 2. Coupland S. Lymphoma (lymphosarcoma) of the prostate: secondary nodules on pancreas and suprarenal capsule . Trans Pathol Soc London 1877;28: 179-85. 3. Fukase N. Hyperplasia of the rudimentary lymph nodes of the prostate. Surg Gynacol Obstet 1922;35: 131-6. 4. Freeman C, Berg JW, Cutler SJ. Occurrence and prognosis of extranodal lymphom as. Cancer 1972;29:252-60. 5. Rosenberg SA, Diamond HD, Jaslowitz 8, Craver LF. Lymphosarcoma: a review of 1269 cases. Med 1961 ;40:31 -84. 6. Zein TA, Huben A, Lane W, Pontes JE, Englander LS. Secondary tumors of the prostate. J Urol198 5;133:615-6. 7. Watson EM, Saucer HR, Sadugor MG . Manifestations of lympho -b lastoma s in the genito-u rinary tract. J Urol 1949;61 :626-45. 8. Weimar G, Culp DA, Loening S, Narayana A. Urogenital involvement by malignant lymphomas. J Urol1981; 125:230-1 . 9. Smith BH, Dehner LP. Sarcoma of the prostate gland. Am J Clin Pathol 1972;58:43-50. 10. Sridhar KN , Woodhouse CR. Prostatic infiltration in leukaemia and lymphoma. Europ Urol1983;9:153-6. 11 . Bostwick DG, Mann RB . Malignant lymphomas involving the prostate. A study of 13 cases. Cancer 1985;56:2932-8. 12. Oesterling JE. Prostate specific antigen: a critical assessment of the most useful tumor marker for adenocarcinoma of the prostate. J Urol1991 ;145:907-23. 13. Lewi HJ, Stewart ID, Seywright M, FlemingS , Deane RF, Kyle KF. Urinary tract lymphoma. Br J Urol1986;58:16-8. 14. Heaney JA, Delellis RA, Rudders RA. Non-Hodgkin lymphoma arising in lower urinary tract. Urol1985;25:479-84. 15. Fell P, O'Connor M, Smith JM. Primary lymphoma of prostate presenting as bladder outflow obstruction. Urol 1987;29:555-6.
Volume 19 Number 4
ISSN: 1079-0268 (Print) 2045-7723 (Online) Journal homepage: http://www.tandfonline.com/loi/yscm20
T-cell Lymphocytic Lymphoma Involving the Prostate Presenting as Elevated PSA in Paraplegia: Case Report Tracy R. Johnson, Douglas B. Barber, Joel M.H. Teichman & Antoinne C. Able To cite this article: Tracy R. Johnson, Douglas B. Barber, Joel M.H. Teichman & Antoinne C. Able (1996) T-cell Lymphocytic Lymphoma Involving the Prostate Presenting as Elevated PSA in Paraplegia: Case Report, The Journal of Spinal Cord Medicine, 19:4, 258-260, DOI: 10.1080/10790268.1996.11719443 To link to this article: http://dx.doi.org/10.1080/10790268.1996.11719443
Published online: 10 May 2016.
Submit your article to this journal
View related articles
Citing articles: 5 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yscm20 Download by: [Australian Catholic University]
Date: 19 August 2017, At: 12:42
T-cell Lympho cytic Lympho ma Involvin g the Prostate Presenti ng as Elevated PSA in Parapleg ia: Case Report 1 Tracy R. Johnson, M.D., Douglas B. Barber, M.D., 12 Antoinne C. Able, M.D. ·
12 ·
23 ·
Joel M.H. Teichman, M.D.,
Downloaded by [Australian Catholic University] at 12:42 19 August 2017
ABSTRACT
The vast majority of cancers that involve the prostate are adenocarcinomas of the duct-acinar secretory epithelium. Other cancers, primarily leukemia and lymphoma, can involve the prostate and lead to an abnormal digital examination or elevated serum prostate specific antigen (PSA) . The case discussed is that of a 62 year-old male with T12 complete with T-cell lymphoma ~araplegia who presented with a persistently elevated PSA and was subsequently diagnosed in the differential included be should prostate the involving l~volving the prostate. Although rare, leukemia and lymphoma 260) Med;19:258Cord Spinal (J prostate. the of oma adenocarcin for diagnosis of patients being evaluated Key words: prostate, lymphoma, paraplegia, prostate specific antigen (PSA) INTRODUCT ION
The vast majority of cancers that arise in the prostate are adenocarcin omas of the duct-acinar secretory epithelium. 1 Clinical suspicion of adenocarcin oma of the prostate commonly results when either an abnormal digital examinatio n or elevated serum prostate specific antigen (PSA), or both, is detected. The diagnosis of adenocarci noma is then confirmed via biopsy. Other cancers, primarily leukemia and lymphoma, can involve the prostate and lead to an abnormal digital examinatio n or elevated PSA. CASE REPORT
The patient, a 62 year old white male with T12 complete paraplegia secondary to a fall in 1989, presented in December, 1992, with a symptomat ic urinary tract infection (UTI). Previous videofluoroscopic urodynamic studies documented a low pressure, high capacity compliant bladder that was managed via clean intermitten t catheteriza tion (CIC). After completion of a seven day course of oral ciprofloxacin for the treatment of E . coli, repeat urinalysis (UA) and cul1
Department of Rehabilitation M edicine. University of Texas Health Science Center at San Antonio. Texas 2 Spinal Cord Injury SeNice. Audie L. Murphy Memorial Veteran s Hospital. San Antonio. Texas 3 Department of Surgery, University of Texas Health Science Center at San Antonio Correspondence: Douglas B. Barber. M.D. Chief. Spinal Cord Injury SeNice ( 1 28) Audie L. Murphy M emoria l Veterans Hospital 7 400 M erton Minter Boulevard San Antonio. TX 78284 Received M ay 2. 1996 Accepted: May 28, 1996
258
ture with sensitivity (C & S) confirmed eradication of the UTI but microscopic hematuria persisted. In addition, the patient reported the new onset of occasional difficulty in passing the catheter. An intravenou s urogram (IVU), cystoscopy and PSA assay were performed. The IVU was unremarkab le. Cystoscopy documented a stricture at the proximal bulb which was dilated without incident. The prostate was noted to be approximat ely 3.5 em in length with prominent lateral lobes. The PSA was elevated at 10.7 ng/ml (normal 0.2-4). The patient subsequently underwent transrectal ultrasound (TRUS) guided random biopsy of the prostate. The biopsies revealed stromal and glandular hyperplasia and chronic inflammati on without evidence of malignancy. Except for an E. coli UTI treated in October, 1993, the patient did well until May, 1994, when he experienced urethral trauma with his CIC program. Repeat PSA at that time noted continued elevation at 9.9 ng/ml. In July, 1994, repeat TRUS guided biopsy of the prostate was performed which demonstrat ed atypical cells consistent with high grade adenocarcinoma. Immunoper oxidase staining was negative for PSA, however, suggesting that the origin of the tumor might be urothelial or other than prostate. Computed tomography (CT) of the abdomen and pelvis showed marked inhomogen ous enhanceme nt and enlargement of the kidneys as well as enlargemen t of the pancreas, prostate and left rectus muscle. Within days after undergoing the CT, the patient complained of abdominal distension, band-like tightness at the T8 level restricting his breath and resulting in shortness of breath and worsening malaise. Physical examina-
Volume 19 Number 4
Downloaded by [Australian Catholic University] at 12:42 19 August 2017
tion was remarkable for left supraclavicular lymphadenopathy approximately 2x2 em in size and rubbery in consistency. Laboratory evaluation at that time was significant for a lymphocytosis; the white blood cell count (WBC) was 29.0 k/mm 3 (normal 4.810.8) with a differential of one percent neutrophils, four percent bands, 92 percent lymphocytes and three percent monocytes. He had a normal hemoglobin of 13.1 g/dl and hematocrit of 38.6 g/dl but thrombocytopenia was present with a platelet count of 45 k/mm 3 (normal 130-400). The patient was hypercalcemic with a serum calcium of 11.9 mg/dl (normal 8.5-10.5) and hyperuricemic with a uric acid of 18.6 mg/dl (normal3.9-9). In addition, liver function tests (LFTs) were elevated including lactate dehydrogenase (LDH) of 1146 U/1 (normall00-225), alkaline phosphatase of 240 (normal 30-115), SGOT of 59 U/1 (normal 8-40) and SGPT of 43 U/1 (normal 5-35). Amylase of 37 U/1 and lipase of 20 U/1 were normal. The patient was admitted with the presumptive diagnosis of lymphoproliferative disorder and received aggressive hydration and allopurinol with resolution of the hypercalcemia. Reexamination of the prostate biopsies with immunohistochemical stains for leukocyte common antigen (LCA) and aT-cell marker (9CD45RO) showed strong positivity in the infiltrating cells, confirming them to be oflymphoid (T-cell) origin (Figure 1). Flow cytometry of peripheral blood as well as bone marrow biopsy confirmed the diagnosis of lymphoblastic lymphoma, T-cortical thymocyte phenotype. The patient received chemotherapy including induction with HOP-1 (vincristine and doxorubicin), consolidation via the Linker regimen (VP-16 and AraC) and at the present time is receiving methotrexate and leucovorin. In addition, the patient received 2400 cGy of prophylactic radiation (XRT) to his calvarium and brainstem. Recent flow cytometry and bone marrow biopsy have revealed that the patient is in remission. In January 1996, the patient's PSA was noted to be 8.8 ng/ml. DISCUSSION
Malignant lymphoma involving the prostate, first described by Coupland in 1877, is a rare phenomenon. 2 Primary prostatic lymphoma without lymph node involvement appears to be particularly rare. Many authors questioned the existence of primary prostatic lymphoma until Fukase demonstrated the presence of lymphoid tissue in normal prostate. 3 In their series of 1467 cases of extranodal non-Hodgkin's lymphoma, ,
Figure 1. Invasion of prostatic stroma and glandu lar epithelium by T-ce ll lymphocytic lymphoma (dark cell s).
Freeman et al. 4 reported that only three (0.2 percent) were prostatic in origin. Rosenberg et al. 5 noted that only one in their series of 1,269 cases of lymphoma (0.08 percent) was of primary prostatic origin. Leukemia and lymphoma are the most common neoplasms reported to metastasize to the prostate. 6 In their series of 600 autopsy examinations of males with non-Hodgkin's lymphoma, Zein et al. 6 found only 49 cases (8.0 percent) with prostatic involvement and none were symptomatic. Other post-mortem studies have documented that approximately 10 percent of patients with non-Hodgkin's lymphoma have infiltration of some portion of the urinary tract, with less than one percent of the patients having urological symptoms.7,B Secondary infiltration of the prostate, although more common than lymphoma of primary prostatric origin, is still considered rare. As a result of the rarity of prostatic involvement by lymphoma, Smith and Dehner9 and Sridhar and Woodhouse 10 distinguished primary prostatic lymphoma from sec-
The Journal of Spinal Cord Medicine
259
Downloaded by [Australian Catholic University] at 12:42 19 August 2017
ondary prostat ic involve ment based upon the site of initial present ation, regardl ess of the presenc e of generalized lympho ma. Our compre hensive review of the literatu re revealed no previou sly reporte d cases of lympho ma of the prostat e occurri ng in a spinal cord injured patient . Able-bodied patient s with prostat ic lympho ma commonly present with sympto ms of urinary frequen cy and urgency and occasio nally with hematu ria and 11 acute urinary retentio n. In most patient s, the prostate was diffusel y enlarge d, nonten der and firm or rubbery on palpati on, similar to soft tissue sarcom as. There was usually no nodula rity but the median furrow was commo nly oblitera ted. System ic sympto ms, includi ng fever, chills, night sweats and weight loss 6 are observe d infrequ ently, and only in patient s with widesp read lympho ma. This appears to be the first report of prostat ic lympho ma diagnos ed as a result of pursuin g the etiology of an abnorm al PSA. The effect of infiltra tion of the prostat e by lympho ma on PSA levels has not been describ ed. We believe that the elevatio n in our patient represe nted a prostat itis that resulte d from the invasio n by lympho ma. Prostat itis is a conditio n 12 known to falsely elevate PSA. Lymph oma of the prostat e carries a poor prognosis, with few patient s survivi ng five years after the diagnos is. 13 The stage and bulk of disease at the time of diagnos is and the histologic classifi cation of the tumor are the two factors that most strongl y impact 14 the length of surviva l. Most recently , treatme nt of malign ant lympho ma of the prostat e has focused on chemot herapy and radiatio n therapy for treatme nt of systemi c disease and surgery for palliati on. Most authors agree that prostat ectomy is not effective in
260
prolong ing surviva l, althoug h it offers sympto matic 11 15 relief of urinary obstruc tion. •
REFERENCES 1. Stamey TA, McNeal JE. Adenocarcinoma of the prostate. In; Walsh PC, et al., eds. Campbell's urology. Philadelphia; W.B. Saunders Company, 1992:1159. 2. Coupland S. Lymphoma (lymphosarcoma) of the prostate: secondary nodules on pancreas and suprarenal capsule . Trans Pathol Soc London 1877;28: 179-85. 3. Fukase N. Hyperplasia of the rudimentary lymph nodes of the prostate. Surg Gynacol Obstet 1922;35: 131-6. 4. Freeman C, Berg JW, Cutler SJ. Occurrence and prognosis of extranodal lymphom as. Cancer 1972;29:252-60. 5. Rosenberg SA, Diamond HD, Jaslowitz 8, Craver LF. Lymphosarcoma: a review of 1269 cases. Med 1961 ;40:31 -84. 6. Zein TA, Huben A, Lane W, Pontes JE, Englander LS. Secondary tumors of the prostate. J Urol198 5;133:615-6. 7. Watson EM, Saucer HR, Sadugor MG . Manifestations of lympho -b lastoma s in the genito-u rinary tract. J Urol 1949;61 :626-45. 8. Weimar G, Culp DA, Loening S, Narayana A. Urogenital involvement by malignant lymphomas. J Urol1981; 125:230-1 . 9. Smith BH, Dehner LP. Sarcoma of the prostate gland. Am J Clin Pathol 1972;58:43-50. 10. Sridhar KN , Woodhouse CR. Prostatic infiltration in leukaemia and lymphoma. Europ Urol1983;9:153-6. 11 . Bostwick DG, Mann RB . Malignant lymphomas involving the prostate. A study of 13 cases. Cancer 1985;56:2932-8. 12. Oesterling JE. Prostate specific antigen: a critical assessment of the most useful tumor marker for adenocarcinoma of the prostate. J Urol1991 ;145:907-23. 13. Lewi HJ, Stewart ID, Seywright M, FlemingS , Deane RF, Kyle KF. Urinary tract lymphoma. Br J Urol1986;58:16-8. 14. Heaney JA, Delellis RA, Rudders RA. Non-Hodgkin lymphoma arising in lower urinary tract. Urol1985;25:479-84. 15. Fell P, O'Connor M, Smith JM. Primary lymphoma of prostate presenting as bladder outflow obstruction. Urol 1987;29:555-6.
Volume 19 Number 4
