AMYLOIDOSIS OF THE SEMINAL VESICLE AND HEMATOSPERMIA

Case 1. A 57-year-old man with a 3-year history of hematospermia presented with palpable prostate cancer. Final pathological examination revealed stage T3aN0Mx Gleason grade 7 adenocarcinoma of the prostate and amyloidosis of the seminal vesicle. Case 2. A 62-year-old man presented with hematospermia several years in duration and palpable prostate cancer. Final pathological evaluation showed stage T3aN0Mx Gleason grade 6 adenocarcinoma of the prostate and amyloidosis of the seminal vesicle. Case 3. A 59-year-old man presented with prostate cancer and 1 episode of hematospermia. Final pathological examination demonstrated stage T2N0Mx Gleason grade 9 adenocarcinoma of the prostate and amyloidosis of the seminal vesicle. DISCUSSION Amyloidosis is a process characterized by deposition of protein in an extracellular subepithelial location in a -pleated sheet conformation. Amyloidosis of the seminal vesicle is isolated, is benign in nature and increases in incidence with age.2 Two previous reports exist of amyloidosis of the seminal vesicle resulting in hematospermia. The first case involved a 49-year-old man with irritative urinary symptoms, inguinal pain and hematospermia treated with seminal vesiculectomy.2 The second involved a 57-year-old male with hematospermia and nodular thickening of the seminal vesicle on endorectal magnetic resonance imaging.3 In that case the diagnosis of amyloidosis was made by ultrasound guided biopsy. To our knowledge this report represents the first documented association between amyloidosis and hematospermia in a prostatectomy series. The patients were seen for biopsy confirmed, clinically localized prostate cancer and described hematospermia before transrectal biopsy. None had urinary complaints or groin pain, and none had undergone preoperative magnetic resonance imaging. The patients were identified from a series of 3,200 radical prostatectomies performed by a single surgeon (PCW). Amyloidosis of the seminal vesicle was reported on final pathological examination in 17 men with an average age of 59 years. The incidence of hematospermia in men with seminal vesicle amyloidosis was 12%. A control group of 34 men was compiled from cases flanking individuals in the study group. None of these controls had amyloidosis of the seminal vesicle or hematospermia (incidence 0%). This difference in hematospermia between the groups was significant (p 0.05). Hematospermia is a clinical complaint of much concern for patients. Its causes are broad and include processes in the seminal vesicle. Benign localized amyloidosis is a rare condition associated with hematospermia. It is not a precursor lesion of systemic amyloidosis, and, thus, additional multisystem investigations are not necessary. The etiology of amyloid induced hematospermia is unknown. We speculate that, like amyloidosis in the kidney, protein deposition may disrupt endothelial integrity, thereby increasing susceptibility to bleeding. This report illustrates the prevalence of amyloidosis of the seminal vesicle in a surgical series and highlights it as a plausible cause of hematospermia that should be considered in the differential diagnosis.