Our appreciation is extended to Drs. Nada Shaker and Anil Parwani at Ohio State University for contributing this case.

History: 

A man in his late thirties presented to the OSU seeking management for a pelvic mass involving the seminal vesicles and prostate due to a three-year duration of intermittent, painless, gross hematuria accompanied by initial episodes of hematospermia, which prompted a CT urogram investigation. The CT indicated a 7.2 cm lobulated ill-defined mass arising from the seminal vesicles.

The persistent mass was identified on CT pelvis following a two-week treatment regimen of levofloxacin and prednisone. The patient ultimately underwent a robotic cystoprostatectomy after progressively severe hematuria and urinary incontinence. On gross examination, the specimen revealed a 9.2 × 7.1 × 7.5 cm diffusely cystic, diffusely necrotic mass appearing to arise from the right half of the prostate. Click images to enlarge.