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Taheri H, Ebrahimi P, Nazari P, Kefayat A, Mahdavian A. An unusual presentation of metastatic prostate cancer in a 44-year-old man: A case report and review of the literature. Clin Case Rep 2024; 12:e8447. [PMID: 38292222 PMCID: PMC10822781 DOI: 10.1002/ccr3.8447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/23/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Prostate cancer is one of the two most common non-cutaneous cancers in men. Its presentation might be with unusual symptoms and cause the wrong initial diagnosis. This case report discusses a rare neurologic manifestation of advanced metastatic cancer in a low-risk man. He had been receiving treatment for multiple sclerosis incorrectly due to unusual manifestations such as claudication and pelvic, leg, and shoulder pain. The patient underwent a whole-body bone scan and then a transrectal ultrasound-guided biopsy, which confirmed metastatic prostate cancer with a Gleason score between 7/10 and 10/10 in all samples. Following treatment with chemotherapeutic injections (docetaxel), luteinizing hormone-releasing hormone (LHRH) analogous (Zoladex), and testosterone-suppressing tablets (abiraterone), the disease has been under control and prostate-specific antigen (PSA) level has decreased significantly. The most common sites of metastasis are regional lymph nodes, bones, and lungs. However, there are reports about the spread of this type of cancer to other parts of the body. Although most patients are diagnosed when the tumor is localized to the prostate, in about 25% of patients, the disease is diagnosed when metastasis has occurred. Some markers can assist physicians in the diagnosis of this disease, such as the Prostate Health Index and the 4 K score. Key Clinical Message The diagnosis of prostate cancer should be considered in all age ranges of adult men. The long-distance metastasis might cause unusual presentations of the disease, such as neurologic, musculoskeletal, and dermatologic symptoms and signs far from the origin of the cancer, before genitourinary manifestations. It is crucial to keep the diagnosis of prostate cancer in mind for men with suggestive signs and symptoms that are not usually detected in this disease.
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Affiliation(s)
- Homa Taheri
- Cedars‐Sinai Cardiology DepartmentBeverly HillsCaliforniaUSA
| | - Pouya Ebrahimi
- Ahvaz Jundishapur University of Medical SciencesAhvazIran
| | - Pedram Nazari
- Cancer Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
| | | | - Abbas Mahdavian
- Urology DepartmentAhvaz Jundishapur University of Medical SciencesAhvazIran
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2
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Liu Y, Dai Z, Hao J, Wang L, Liu Z. Cervical lymphadenopathy as initial presentation of metastatic prostate cancer: A retrospective study of five cases and literature review. Front Surg 2023; 10:1081951. [PMID: 36793314 PMCID: PMC9922865 DOI: 10.3389/fsurg.2023.1081951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023] Open
Abstract
Cervical lymphadenopathy as the initial presentation of metastatic prostate cancer is particularly uncommon, and easily misdiagnosed. In the current study, we describe five cases of metastatic prostate cancer in our hospital that presented with cervical lymphadenopathy as an initial symptom. The diagnosis was confirmed by needle biopsy of the suspicious lymph nodes and the serum prostate specific antigen (PSA) levels of all patients exceeded 100 ng/ml. The five patients were treated with hormonal therapy; four received traditional hormonal therapy, including bicalutamide and goserelin; one patient received hormonal therapy that included abiraterone and goserelin. Case 1 developed into castration-resistant prostate cancer (CRPC) after 7 months and died after 12 months. Case 2 rejected regular hormonal therapy for personal reasons and died 6 months after the initial diagnosis. Case 3 was still alive at the time of writing. Case 4 was administered with abiraterone, prednisolone and goserelin; the treatment was effective and the patient has remained symptom-free for the last 24 months. Case 5 was treated with hormonal and chemotherapy but died 8 months after diagnosis. In conclusion, any elderly male presenting with cervical lymphadenopathy should be considered the possibility of prostate cancer, especially when the needle biopsy reveals adenocarcinoma. The prognosis for patients presented with cervical lymphadenopathy as the initial presentation is usually poor. Hormone therapy based on abiraterone may yield a better response in such cases.
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Affiliation(s)
- Yangyang Liu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China,Department of Emergency, Xijing Hospital in Xi’an City, Xi’an, Shanxi, China
| | - Zhihong Dai
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jiange Hao
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liang Wang
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China,Correspondence: Zhiyu Liu Liang Wang
| | - Zhiyu Liu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China,Correspondence: Zhiyu Liu Liang Wang
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3
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Dattani SM, Yamada ML, Dhoot NM, Ghazala G, Levene A, Somsundaram R. Metastatic prostate cancer presenting as incidental pelvic lymphadenopathy – a report of three cases with literature review. Radiol Case Rep 2022; 17:2247-2252. [PMID: 35496745 PMCID: PMC9052084 DOI: 10.1016/j.radcr.2022.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/13/2022] [Accepted: 03/13/2022] [Indexed: 11/17/2022] Open
Abstract
The presence of metastatic lymph nodes is a poor prognostic factor in patients with prostate cancer. Currently, there is no national prostate cancer screening program through prostate-specific antigen testing and the benefits of initiating such a scheme have not yet been proven. However, an informed choice program is in place, on request, for men over the age of 50, following discussion with a healthcare professional and an assessment of the potential benefits. This test is also available to men presenting with lower urinary tract symptoms. We report three cases in men who were imaged for non-specific reasons and found to have pelvic lymphadenopathy. The patients reported no urinary symptoms and all were subsequently diagnosed as metastases from a prostatic primary. As this diagnosis was not considered at an earlier stage, there was a delay in initiating appropriate treatments.
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Affiliation(s)
- Seyan M.T. Dattani
- Biology Student, University College London, PACS Assistant, Luton and Dunstable University Hospital, Luton, UK
| | - Maria Luiza Yamada
- Department of Radiology, Luton and Dunstable University Hospital. Luton-LU4 0DZ, UK
| | - Nilu Malpani Dhoot
- Department of Radiology, Luton and Dunstable University Hospital. Luton-LU4 0DZ, UK
- Corresponding author.
| | - Gamal Ghazala
- Department of Radiology, Luton and Dunstable University Hospital. Luton-LU4 0DZ, UK
| | - Adam Levene
- Cellular Pathology, Luton and Dunstable University Hospital, Luton, UK
| | - Ramkumar Somsundaram
- Department of Radiology, Luton and Dunstable University Hospital. Luton-LU4 0DZ, UK
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4
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Jayasinghe KI, Abeysinghe AHMGB. Sarcomatoid carcinoma of the prostate presenting as bilateral cervical lymphadenopathy: a rare case report. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sarcomatoid carcinoma (also called carcinosarcoma in the latest WHO classification 2016) of the prostate gland is a biphasic malignant neoplasm which exhibits epithelial and mesenchymal differentiation [1]. Sarcomatoid carcinoma is a rare tumour, considered as a variant of acinar adenocarcinoma in the WHO classification, with less than 200 reported cases in the literature to date [2]. Sarcomatoid carcinoma of prostate presenting with bilateral cervical lymph node deposits as the first clinical manifestation, is even rarer, and reported cases were not found in the literature; hence, this is the first case report of such, to the best of our knowledge.
Case presentation
We report a case of sarcomatoid carcinoma of the prostate in a 72-year-old Sri Lankan man who presented with bilateral cervical lymphadenopathy. He had hard nodular prostate on digital rectal examination (DRE). Ultrasound scan of abdomen (USS) revealed the presence of paraaortic lymphadenopathy, in addition. The excision biopsy of the right cervical lymph node revealed deposit of a carcinoma of epithelioid histomorphology, which showed patchy strong positivity for immunohistochemical marker (IHCm), PSA. His serum PSA value was 48 ng/ml (reference < 5.40 ng/ml). Contrast-enhanced computed tomography (CECT) showed mildly enlarged prostate gland with irregular outline, sclerotic lesions in cervico-thoracic and lumbosacral vertebrae and generalized lymphadenopathy. Transrectal ultrasound guided biopsy of the prostate revealed sarcomatoid carcinoma. Disseminated sarcomatoid carcinoma of prostate was diagnosed. The patient has undergone bilateral orchidectomy, marking a serum PSA value of 5.4 ng/ml two months thereafter. He is surviving for six months after diagnosis and is currently under chemotherapy with docetaxel for the disseminated disease.
Conclusion
Sarcomatoid carcinoma can present with cervical lymphadenopathy with absent lower urinary tract symptoms. In elderly patients with cervical lymphadenopathy, serum PSA, DRE and trans-rectal ultrasound scan are advocated to rule out prostate cancer. Immunohistochemical markers are required for the diagnosis of primary tumour and secondary deposit of sarcomatoid carcinoma of prostate.
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5
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Chua AV, Chu ACS, Tawasil AA, San Juan MD. Metastatic prostate cancer mimicking a rectal cancer: a case report. Ecancermedicalscience 2021; 15:1295. [PMID: 34824618 PMCID: PMC8580598 DOI: 10.3332/ecancer.2021.1295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 11/06/2022] Open
Abstract
The most common presenting symptoms of prostate cancer, a common cancer in males worldwide, are lower urinary tract symptoms. In rare cases, however, urinary symptoms may not be apparent, and patients can present with gastrointestinal symptoms instead. Even rarer is the involvement of non-regional lymph nodes such as the cervical nodes. Here, we report a case of a 50-year-old male who initially presented with constipation and an enlarging left lateral neck mass. Further work-up revealed metastatic prostatic adenocarcinoma and the patient dramatically responded to chemotherapy, androgen deprivation therapy and bone support therapy. This case highlights the importance of considering a prostate malignancy in a male patient presenting with gastrointestinal symptoms and a neck mass even in the absence of lower urinary tract symptoms. Serum prostate specific antigen, pathologic findings and immunohistochemistry staining are important to guide the clinician in making the correct diagnosis and treatment.
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Affiliation(s)
- Alfredo V Chua
- Division of Medical Oncology, Department of Medicine, University of the Philippines - Philippine General Hospital, Taft Avenue, Ermita, Manila 1000, Philippines
| | - Alvin Christopher S Chu
- Department of Laboratories, University of the Philippines - Philippine General Hospital, Manila 1000, Philippines
| | - Ashraf A Tawasil
- Division of Gastroenterology, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila 1000, Philippines
| | - Michael D San Juan
- Division of Medical Oncology, Department of Medicine, University of the Philippines - Philippine General Hospital, Taft Avenue, Ermita, Manila 1000, Philippines
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6
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Silver E, Roudakova K, Bial N, Daniel D. Cutaneous Metastasis of Renal Cell Carcinoma to the Cheek: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928999. [PMID: 33770067 PMCID: PMC8011281 DOI: 10.12659/ajcr.928999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patient: Male, 72-year-old Final Diagnosis: Renal cell carcinoma Symptoms: Mass Medication:— Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Eric Silver
- Department of Oral and Maxillofacial Surgery, Kings County Hospital Center, Brooklyn, NY, USA
| | - Kseniya Roudakova
- Department of General Surgery, Kings County Hospital Center, Brooklyn, NY, USA
| | - Nicholas Bial
- Department of Oral and Maxillofacial Surgery, Kings County Hospital Center, Brooklyn, NY, USA
| | - David Daniel
- Department of Pathology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
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7
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Mbwambo OJ, Mremi A, Mbwambo JS, Bright F, Mteta AK, Ngowi BN. Virchow's node as the initial presentation of metastatic prostate cancer: a case series of a common cancer in uncommon location. J Surg Case Rep 2020; 2020:rjaa476. [PMID: 33294165 PMCID: PMC7703372 DOI: 10.1093/jscr/rjaa476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
Prostate cancer is one of the commonest cancers among men contributing significantly to the overall cancer burden globally. Most patients present with lower urinary tract symptoms. Metastasis to supraclavicular lymph nodes is unusual presentation, which has been rarely reported particularly as the primary presentation. We report two rare cases of advanced prostatic adenocarcinoma presenting with firm, non-tender lump in the left supraclavicular region between the two heads of the sternocleidomastoid muscle, (that is Virchow’s node) as initial primary symptom. Examination of the patients revealed an elevated prostatic-specific antigen (PSA) of > 100 ng/ml levels, and the diagnosis was confirmed by histological evaluation and immunostaining with PSA of the supraclavicular lymph nodes and prostate biopsies. This case series emphasizes the importance of considering prostate cancer in the differential diagnosis of male patients with supraclavicular lymphadenopathy.
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Affiliation(s)
- Orgeness J Mbwambo
- Department of Urology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Alex Mremi
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jasper S Mbwambo
- Department of Urology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Frank Bright
- Department of Urology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Alfred K Mteta
- Department of Urology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Bartholomeo N Ngowi
- Department of Urology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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8
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Kale S, Rashid T. Carcinoma of prostate masquerading as retroperitoneal lymphoma. Urol Case Rep 2020; 33:101323. [PMID: 33102025 PMCID: PMC7573841 DOI: 10.1016/j.eucr.2020.101323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 11/24/2022] Open
Abstract
Prostate cancer is the fifth most common malignancy worldwide and the second most common in men. It usually metastasizes to bony skeleton, followed by lung, liver, pleura and adrenals. We report a 71 year old male patient who initially presented only with retroperitoneal lymphadenopathy and constitutional symptoms, misleading the diagnosis of retroperitoneal lymphoma. Who later on was discovered to have carcinoma prostate.
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9
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Metastatic Adenocarcinoma of the Prostate Presenting as Supraclavicular and Bulky Generalized Lymphadenopathy with a Benign Digital Rectal Exam. Urol Case Rep 2017; 13:128-130. [PMID: 28567325 PMCID: PMC5440741 DOI: 10.1016/j.eucr.2017.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/13/2017] [Indexed: 11/21/2022] Open
Abstract
A 63-year-old male presented with complaints of an enlarging left supraclavicular mass and weight loss. Computed tomography demonstrated a large retroperitoneal mass causing displacement of the adjacent organs, and moderate left hydroureteronephrosis. Multiple pulmonary nodules, lytic spinal lesions, and generalized lymphadenopathy including the left supraclavicular region were seen. Serum prostate-specific antigen level was 2064.0 ng/mL. Digital rectal exam revealed an enlarged prostate without nodularity. Biopsy of the supraclavicular node demonstrated prostatic adenocarcinoma. The diagnosis of lymphoma may be initially suggested, however, prostatic origin should be considered even when the prostate exam is not grossly abnormal.
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10
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Bhattar R, Maheshwari A, Yadav SS, Tomar V. Unusual Presentation of Prostate Carcinoma: A Case Report. J Clin Diagn Res 2017; 11:PD06-PD07. [PMID: 28384931 DOI: 10.7860/jcdr/2017/24584.9250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/08/2016] [Indexed: 11/24/2022]
Abstract
Prostate cancer is a common cancer in elderly men and it frequently metastasizes to regional lymph nodes and sometimes to bone. Very rarely in some of the cases it also shows involvement of non-regional lymph nodes like supra-diaphragmatic lymph nodes. In our report, we present a 60-year-old male, initially misdiagnosed as Chronic Obstructive Pulmonary Disease (COPD) with cervical lymph node involvement may be due to infective region or inflammatory pathology, which was later found to have prostatic adenocarcinoma metastatic to supraclavicular lymph nodes. Very less case reports are present which have shown similar presentations. So we would like to highlight that prostatic carcinoma can be present in an atypical form also.
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Affiliation(s)
- Rohit Bhattar
- Resident, Department of Urology, SMS Medical College , Jaipur, Rajasthan, India
| | - Anuradha Maheshwari
- Clinical Associate, Department of Anaesthesia, EHCC , Jaipur, Rajasthan, India
| | - Sher Singh Yadav
- Professor and Head, Department of Urology, SMS Medical College , Jaipur, Rajasthan, India
| | - Vinay Tomar
- Professor, Department of Urology, SMS Medical College , Jaipur, Rajasthan, India
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11
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López F, Rodrigo JP, Silver CE, Haigentz M, Bishop JA, Strojan P, Hartl DM, Bradley PJ, Mendenhall WM, Suárez C, Takes RP, Hamoir M, Robbins KT, Shaha AR, Werner JA, Rinaldo A, Ferlito A. Cervical lymph node metastases from remote primary tumor sites. Head Neck 2015; 38 Suppl 1:E2374-85. [PMID: 26713674 DOI: 10.1002/hed.24344] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/14/2015] [Accepted: 10/17/2015] [Indexed: 11/08/2022] Open
Abstract
Although most malignant lymphadenopathy in the neck represent lymphomas or metastases from head and neck primary tumors, occasionally, metastatic disease from remote, usually infraclavicular, sites presents as cervical lymphadenopathy with or without an obvious primary tumor. In general, these tumors metastasize to supraclavicular lymph nodes, but occasionally may present at an isolated higher neck level. A search for the primary tumor includes information gained by histology, immunohistochemistry, and evaluation of molecular markers that may be unique to the primary tumor site. In addition, 18F-fluoro-2-deoxyglocose positron emission tomography combined with CT (FDG-PET/CT) has greatly improved the ability to detect the location of an unknown primary tumor, particularly when in a remote location. Although cervical metastatic disease from a remote primary site is often incurable, there are situations in which meaningful survival can be achieved with appropriate local treatment. Management is quite complex and requires a truly multidisciplinary approach. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2374-E2385, 2016.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Carl E Silver
- Departments of Surgery and Otolaryngology, Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Missak Haigentz
- Departments of Medicine (Oncology) and Otorhinolaryngology-Head & Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Justin A Bishop
- Departments of Pathology, The Johns Hopkins University, Baltimore, Maryland
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Patrick J Bradley
- Department of Otolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, United Kingdom
| | | | - Carlos Suárez
- University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and Cancer Center, Brussels, Belgium
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jochen A Werner
- Department of Otolaryngology, Head and Neck Surgery, Marburg, Germany
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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12
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Prostate cancer metastatic to the cervical lymph nodes. Case Rep Urol 2015; 2015:263978. [PMID: 25821627 PMCID: PMC4364005 DOI: 10.1155/2015/263978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/31/2015] [Accepted: 02/19/2015] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer is the most common cancer in men, often presenting with regional lymph node or bone metastasis and rarely with supradiaphragmatic lymph node involvement. Most metastatic cancers involving the cervical lymph nodes are from cancers of the upper aerodigestive tract. In this report, we describe two cases with cervical lymph node enlargement due to metastatic prostate cancer as the initial clinical presentation: a 43-year-old male, initially misdiagnosed with a tumor of the upper aerodigestive tract and an 87-year-old male with right lobe pneumonia and cervical lymph node enlargement, initially attributed to be an acute inflammatory lymph node reaction. To the best of our knowledge, there are less than 50 cases reported in the literature of adenocarcinoma of prostate metastatic to the cervical lymph nodes and only one case presenting in men younger than 45 years. The authors intend to highlight the importance of digital rectal exam and PSA test in case of persistent left cervical lymph node enlargement, including men younger than 45 years of age.
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13
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Chan G, Domes T. Supraclavicular lymphadenopathy as the initial presentation of metastatic prostate cancer: A case report and review of literature. Can Urol Assoc J 2013; 7:E433-5. [PMID: 23826058 DOI: 10.5489/cuaj.1385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Prostate cancer usually metastasizes to the regional lymph nodes, and distal metastases to supraclavicular lymph nodes are rarely reported, especially as an initial presentation. Limited case reports describe cervical lymphadenopathy as the initial presentation of metastatic prostate cancer, and often with widely disseminated disease. Patients with this initial presentation rarely undergo digital rectal examination or serum prostate-specific antigen (PSA) level measurement as part of their initial investigations. A high index of suspicion is necessary to make the diagnosis of prostate cancer in this clinical setting. We present a rare case of prostate carcinoma presenting with supraclavicular lymph node enlargement at the initial diagnosis. A review of the relevant literature is provided.
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Affiliation(s)
- Garson Chan
- College of Medicine, University of Saskatchewan, Saskatoon, SK
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14
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Chiang KH, Hung SH, Chang ST. Pneumothorax as a Presenting Clinical Manifestation of Metastatic Prostate Cancer. World J Oncol 2013; 4:118-121. [PMID: 29147342 PMCID: PMC5649679 DOI: 10.4021/wjon630w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2013] [Indexed: 11/24/2022] Open
Abstract
Pulmonary metastases are not encountered commonly in patients with prostate cancer. Pulmonary metastases with pneumothorax as a presenting clinical manifestation in newly diagnosed prostate cancer are very rare. Here, we present the case of an 82-year-old patient who was admitted to our center with a chief complaint of worsening dyspnea over the past few days. The chest X-ray and computed tomography (CT) showed left pneumothorax and bilateral lung opacities as well as generalized lymphadenopathy and diffuse bony metastases. After a series of workup including cervical lymph node biopsy with immunohistochemical staining, abdomen CT, serum prostate-specific antigen (PSA), and transrectal ultrasonography (TRUS), he was proved to have prostate cancer with multiple lung, bone and lymph node metastases. This case is reported because of the rarity for a prostate carcinoma presented clinically with an unusual pulmonary manifestation.
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Affiliation(s)
- Kuo-Hwa Chiang
- Division of Chest Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Information Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Shun-Hsing Hung
- Department of Urology, Chi Mei Medical Center, Tainan, Taiwan
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15
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Elabbady A, Kotb AF. Unusual presentations of prostate cancer: A review and case reports. Arab J Urol 2012; 11:48-53. [PMID: 26579245 PMCID: PMC4442930 DOI: 10.1016/j.aju.2012.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 10/29/2012] [Accepted: 10/29/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To report our institutional experience with some rare presentations of prostate cancer, as prostate cancer is a common problem and affects a large group of men during their lifetime, but a few studies report unusual presentations of metastatic prostate cancer. Methods All possible clinical and pathological data were collected for six relevant patients with prostate cancer and unusual metastases who were identified at our institution. PubMed was searched for unusual presentations of prostate cancer in the last 20 years (1982–2012) and all relevant publications were assessed. The authors discussed the reports and selected those articles of major clinical significance to include in a review. Results We identified 19 reports of major clinical significance and reviewed them. As in the cases from our institution, supraclavicular lymphadenopathy, isolated upper ureteric obstruction and severe obstructing constipation were some of the rare presentations encountered at other institutions, and reported mostly as sporadic case-reports. Conclusion Prostate cancer should be always considered in the differential diagnosis of elderly men presenting with supraclavicular lymphadenopathy, hydroureteronephrosis or constipation, even in the presence of a normal digital rectal examination and low serum total prostate-specific antigen (PSA) levels. PSA immunohistochemical staining should be used in doubtful cases.
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Affiliation(s)
- Ahmed Elabbady
- Department of Urology, Alexandria University, Alexandria, Egypt
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16
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Dubhashi SP, Kumar H, Nath SR. Prostate cancer presenting as cervical lymphadenopathy. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:206-8. [PMID: 23569530 PMCID: PMC3615993 DOI: 10.12659/ajcr.883334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 06/18/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prostate cancer is the most common cancer in men in many Western countries and is the second-leading cause of cancer in men. More than 30% of men over the age of 50 will develop a malignant change in the prostate. Common sites of metastasis include bone and regional lymph nodes. CASE REPORT This is a case report of prostate cancer in an elderly man presenting with cough and cervical lymphadenopathy. The lymph node cytology reported moderately differentiated adenocarcinoma, and immunohistochemistry of the biopsy specimen with PSA staining demonstrated the malignancy to be of prostatic origin. The patient responded dramatically to androgen blockade therapy. Clearing of chest infiltrates and regression in size of cervical lymph nodes were evident within 6 months. CONCLUSIONS Prostate cancer should be considered as one of the differential diagnoses of generalized lymphadenopathy in males with adenocarcinoma of undetermined origin, even in the absence of lower urinary tract symptoms. Immunohistochemistry with PSA staining can confirm the diagnosis. Hormonal therapy is an effective treatment modality, even in patients with an advanced stage of disease.
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Aldridge T, Kusanale A, Colbert S, Brennan PA. Supraclavicular metastases from distant primaries: what is the role of the head and neck surgeon? Br J Oral Maxillofac Surg 2012; 51:288-93. [PMID: 22591766 DOI: 10.1016/j.bjoms.2012.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 03/23/2012] [Indexed: 01/08/2023]
Abstract
Suspicious malignant supraclavicular lymphadenopathy provides a challenge for diagnosis and treatment. The wide variety of primary tumours that metastasise to this region should alert the clinician to look beyond the head and neck, particularly if it is the only site in the neck with suspected disease. As metastatic spread to these nodes from primaries not in the head and neck often indicates wide spread disease, neck dissection is controversial. In this article we review the lymphatic anatomy and discuss the investigation of supraclavicular lymphadenopathy. We discuss the evidence for the management of the neck in patients with subclavicular primary cancers (excluding lymphoma and melanoma) and the role of neck dissection.
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Affiliation(s)
- Tom Aldridge
- Department of Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK.
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Yamamoto T, Tominaga Y, Tsuzuki T, Hiramitsu T, Nanmoku K. Metastatic prostate carcinoma detected at lymph node dissection for thyroid papillary carcinoma: report of a case. Int Cancer Conf J 2012. [DOI: 10.1007/s13691-011-0003-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sagnak L, Topaloglu H, Gucuk O, Han U, Ersoy H. Skip Metastase on the Left Neck Lymph Nodes of the Prostatic Adenocarcinoma with Neuroendocrine Differentiation and Accompanying Thyroid Micropapillary Carcinoma. Pathol Oncol Res 2008; 14:493-5. [DOI: 10.1007/s12253-008-9029-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Accepted: 03/05/2008] [Indexed: 11/29/2022]
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Gerogianni I, Gravas S, Papadopoulos D, Terzis A, Nakou M, Tzortzis V, Gourgoulianis K, Melekos MD. Endobronchial metastasis from prostate cancer. Int Urol Nephrol 2008; 40:961-4. [PMID: 18368505 DOI: 10.1007/s11255-008-9369-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Accepted: 03/05/2008] [Indexed: 11/26/2022]
Abstract
We report a case of endobronchial metastasis from prostate adenocarcinoma. A patient with a history of prostate cancer under complete androgen blockade presented to the respiratory department complaining of dyspnea and dry coughing. Flexible bronchoscopy showed multiple polypoid lesions in the tracheobronchial tree and the immunohistochemical studies on the biopsy specimen determined the diagnosis. The patient was treated with paclitaxel, estramustine phosphate and carboplatine, and experienced symptoms suppression. To our knowledge, this is the first case of endobronchial metastasis of a patient with androgen refractory prostate cancer without any evidence of extrathoracic metastasis. The current report also emphasises the need for a multidisciplinary approach for cases of endobronchial metastases, with the collaboration of pneumologists, urologists, pathologists and oncologists.
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Affiliation(s)
- Irini Gerogianni
- Respiratory Medicine Department, University Hospital of Larissa, Larissa, Greece
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