Autopsy, Forensic, Grossing 004 Id: EP3 Prostate Adenocarcinoma Metastasis to the Bilateral Ureters: An Unusual Pattern Suvra Roy, MD, L. Maximilian Buja, MD, University of Texas Health Science Center at Houston We report an autopsy of a patient with prostate cancer who had hydronephrosis and sepsis due to obstruction from Downloaded from https://academic.oup.com/ajcp/article/144/suppl_2/A004/1772163 by guest on 23 September 2021 bilateral ureteral metastasis of prostate adenocarcinoma. He was an 82-year-old man who presented to the emergency department with weakness and shortness of breath. Fifteen years earlier, he had been diagnosed with prostate cancer , underwent chemotherapy, and was in remission for 10 years. Eighteen months ago, he developed a recurrence and began chemotherapy again but, because of his worsening renal condition, stopped the chemotherapy about 4 months ago. On admission, he was found to have chronic kidney disease, stage 5, and sepsis. Abdominal CT was negative for genitourinary mass. His condition deteriorated rapidly and he developed bradycardia and then pulseless electrical activity (PEA). He went into cardiac arrest for 30 minutes without return of pulse and remained in PEA. His poor prognosis was explained to his family and, per the family’s wishes, resuscitation was stopped, and the patient died. Autopsy revealed bilateral dilated renal pelvis, trabeculated urinary bladder and enlarged prostate. No gross evidence of metastasis was identified in lymph nodes or bone. However, the openings of the ureters revealed papillary masses involving the distal ureters bilaterally, but not involving the bladder. Microscopic examination of the masses revealed atypical tumor cells with highly pleomorphic features. Some focal areas also showed nuclei with “salt and pepper” features. Residual nests of adenocarcinoma were identified in the prostate. Immunohistochemistry was positive for prostate-specific antigen and prostatic acid phosphatase; and negative for pankeratin, synaptophysin and chromogranin. These findings are consistent with metastasis from prostate adenocarcinoma. This patient manifests a very unusual pattern of metastasis of prostate adenocarcinoma with massive involvement of the ureters. In spite of the unusual pattern, ureteral metastasis should be considered in the differential diagnosis of a patient with prostate cancer with urinary obstruction. © American Society for Clinical Pathology Am J Clin Pathol 2015;144:A004 .