New England Section of the American Urological Association

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George Langstaff (1780-1846): Surgeon, Pathologist, Museum Curator, and the First to Observe Prostate Cancer during Post-Mortem Examination
Kamyar Ghabili Amirkhiz, MD1, Sasha Druskin, MD2, Jeffrey Tosoian, MD3, Michael Leapman, MD1, Christian Pavlovich, MD2, Ashley Ross, MD, PhD2, Preston Sprenkle, MD1
1Yale School of Medicine, New Haven, CT, 2The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, 3University of Michigan, Ann Arbor, MI

BACKGROUND
George Langstaff was an English surgeon and pathologist in the early 1800s. Here, we review his early life and the contributions he made to our early understanding of prostate cancer.
METHODS
Using PubMed, and Google Scholar, a comprehensive literature review was conducted to investigate Dr. Langstaff’s early life and work in the field of prostate cancer. We also reviewed his paper published in Medico-Chirurgical Transactions in 1817, which is notable as the first gross anatomic description of prostate cancer.
RESULTS
George Langstaff was born in Richmond, Yorkshire, England in 1780, and died in London on August 15th, 1846. After training at St. Bartholomew’s Hospital, Dr. Langstaff received his diploma from the Royal College of Surgeons in 1804, and worked as a surgeon in the parish of St. Giles Cripplegate church, and later was appointed as a surgeon to the parish workhouse in 1813. As a surgeon and a pathologist in the workhouse, he had access to numerous post-mortem specimens, from which he established a museum. His drawings of these specimens were later published in the ten-volume catalogue raisonné, which included illustrations of 2380 normal and abnormal human specimens. Notably, he published a paper including six cases of "Fungus Haematodes" in Medico-Chirurgical Transactions in 1817. He used this term to describe tumors which would bleed due to ‘fungus-like’ growth if situated on the external part of the body. In his case of "Fungus Haematodes in the Urinary Bladder, Liver, and Lungs", Dr. Langstaff described a 68-year old man who presented with pain in his bilateral flanks and hypogastric region, lower urinary tract symptoms, and hematuria. Dr. Langstaff noted an enlarged prostate on digital rectal examination, and moderate membranous urethral obstruction. On post-mortem examination, Dr. Langstaff found an ingrowing tumor in the bladder. He recounted the origin of the bladder tumor as "… from the prostate gland, chiefly from the middle, or third lobe." He observed the tumor extending laterally from posterior part of the bladder to the ureteral orifices. He also found that the prostatic urethra was almost obstructed due to the tumor, and he detected several lesions with similar "fungoid" nature in both the liver and lungs.
CONCLUSIONS
George Langstaff had a meticulous approach to investigating post-mortem specimens and is likely the first person to describe metastatic prostate cancer from a gross anatomic perspective.


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