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Dills A, Obi O, Bustos K, Jiang J, Gupta S. Cutaneous Metastasis of Prostate Adenocarcinoma: A Rare Presentation of a Common Disease. J Investig Med High Impact Case Rep 2021; 9:2324709621990769. [PMID: 33596692 PMCID: PMC7897805 DOI: 10.1177/2324709621990769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Prostate cancer is the most common cancer affecting men in the United States and the second greatest cause of cancer-related death. Metastases usually occur to bone followed by distant lymph nodes and then viscera. Cutaneous metastases are extremely rare. Their presence indicates advanced disease and a poor prognosis. As they are highly variable in appearance and may mimic a more benign process, biopsy is essential for identification. Serine proteases, particularly human tissue kallikreins, may play an important role in promoting metastasis and facilitate infiltration of the skin. Individual cancer genetics may predispose to more aggressive cancer and thus earlier and more distant metastases. In this article, we report our case of a 67-year-old man with a 4-year history of castrate-resistant prostate cancer with cutaneous metastases confirmed by histology. Despite multiple lines of systemic therapy, the patient suffered progressive disease with worsening performance status and was enrolled in hospice.
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Affiliation(s)
| | - Okechukwu Obi
- John H Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Kevin Bustos
- John H Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Jesse Jiang
- John H Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Shweta Gupta
- John H Stroger Jr. Hospital of Cook County, Chicago, IL, USA
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Abstract
Prostate cancer remains the most common noncutaneous cancer in men, especially in this era of prostate-specific antigen assay. Prostate cancer metastases have been known to commonly affect the lymphatics, bones, and lungs. Prostate cancer metastasis to the skin is very rare (<1%) and often signifies a terminal disease. Involvement of the skin has been thought to be through lymphatic spread by embolization or permeation, hematogenous spread, and implantation during surgery (port site in radical prostatectomy). We report a 74-year-old man on management for advanced prostate cancer with subcutaneous goserelin (Zoladex) but developed skin metastasis in the course of treatment. The skin metastasis in our patient, however, was initially localized to the site of the regions of subcutaneous goserelin injection that we imagined if there is a link between the two. We reviewed the literature and currently found no connection. Is there truly a link?
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Affiliation(s)
- Timothy Uzoma Mbaeri
- Department of Surgery, Division of Urology, Nnamdi Azikiwe University, Awka, Nigeria
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3
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Abusultan M, Hanzel P, Durcansky D, Hajtman A. Left Supraclavicular Lymphadenopathy as the Only Clinical Presentation of Prostate Cancer: A Case Report. Acta Medica Martiniana 2017. [DOI: 10.1515/acm-2017-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Prostate cancer usually metastasis to the regional lymph nodes and can rarely metastases to nonregional supradiaphragmatic lymph nodes. Cervical lymph node metastasis of prostate cancer is extremely rare. However, it should be considered in the differential diagnosis of cervical lymphadenopathy in male patients with adenocarcinoma of unknown primary site. In this report we present a rare case of metastatic prostate adenocarcinoma with left supraclavicular lymphadenopathy as the only clinical presentation with no other evidence of metastasis to the regional lymph nodes or bone metastasis.
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Affiliation(s)
- Mohanad Abusultan
- Department of Otorhinolaryngology, Prievidza Hospital, Prievidza , Slovak Republic
| | - Pavel Hanzel
- Comenius University, Jessenius Faculty of Medicine and University Hospital in Martin, Clinic of Otorhinolaryngology, Head and Neck Surgery, Martin , Slovak Republic
| | - D. Durcansky
- Department of Pathology, Prievidza Hospital, Prievidza , Slovak Republic
| | - A. Hajtman
- Department of Pathology, Prievidza Hospital, Prievidza , Slovak Republic
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4
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Affiliation(s)
- Jonathan D.K. Trager
- Department of Dermatology, The New York Hospital-Cornell Medical Center, New York, New York
| | - Victor G. Prieto
- Department of Pathology, The New York Hospital-Cornell Medical Center, New York, New York
| | - N. Scott McNutt
- Department of Pathology, The New York Hospital-Cornell Medical Center, New York, New York
| | - Richard D. Granstein
- Department of Dermatology, The New York Hospital-Cornell Medical Center, New York, New York
| | - Rachelle A. Scott
- Department of Dermatology, The New York Hospital-Cornell Medical Center, New York, New York
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5
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Szwed EA, Sliesoraitis S, Nguyen TC, Nguyen MN, Moreb JS, Zlotecki RA, Crispen PL, Dang NH, Dang LH. New primary malignancy masquerading as metastatic prostate adenocarcinoma. Case Rep Oncol Med 2015; 2015:358572. [PMID: 25789189 DOI: 10.1155/2015/358572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/24/2015] [Indexed: 11/17/2022] Open
Abstract
In the management of patients with prostate cancer, the development of new radiographic findings can mimic progression of the disease, thereby triggering changes in treatment. Typically, clinicians evaluate additional parameters, such as symptoms and prostate specific antigen (PSA) levels, for further evidence of disease progression. In the absence of additional findings, for example, elevated PSA, the possibility of an additional malignancy should be considered and evaluated. We present three cases of patients undergoing treatment for prostate adenocarcinoma and discovered on imaging to have findings suggestive of disease progression, but ultimately found to be a new primary malignancy. Our cases suggest that, in patients with prostate cancer, the appearance of new lymphadenopathy or bone lesions cannot be assumed to solely represent progression of the prostate cancer and warrant further investigation, especially in the presence of stable PSA levels.
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Joshi P, Lele V. Prostatic Adenocarcinoma Masquerading as Generalized lymphadenopathy and Mimicking lymphoma on FDG PET/CT: Diagnosis, Staging, and Evaluation of Therapy Response by FDG PET/CT. Nephrourol Mon 2013; 4:482-4. [PMID: 23573472 PMCID: PMC3614268 DOI: 10.5812/numonthly.2303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 09/27/2011] [Accepted: 10/11/2011] [Indexed: 11/17/2022] Open
Abstract
We report a case of prostatic adenocarcinoma, initially presenting with generalized lymphadenopathy, and mimicking lymphoma on flurodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT). Our case suggests that in elderly men presenting with generalized lymphadenopathy, the diagnosis of metastatic prostatic carcinoma should not be overlooked even in the absence of typical urinary symptoms.The establishment of a diagnosis of metastatic prostate carcinoma is important, because even widespread prostate cancer may be responsive to hormonal treatment, as demonstrated by this case.We also describe the use of FDG PET/CT to diagnose, stage, and evaluate response to hormonal treatment in a given patient.
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Affiliation(s)
- Prathamesh Joshi
- Department of Nuclear Medicine and PET-CT,Jaslok Hospital and Research Centre, Mumbai, India
- Corresponding author: Prathamesh Joshi, Department of Nuclear Medicine and PET-CT, Jaslok Hospital and Research Centre, Worli, Mumbai-26, India. Tel.: +98-912266573244, Fax: +98-912266573244, E-mail:
| | - Vikram Lele
- Department of Nuclear Medicine and PET-CT,Jaslok Hospital and Research Centre, Mumbai, India
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7
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Petcu EB, Gonzalez-Serva A, Wright RG, Slevin M, Brinzaniuc K. Prostate carcinoma metastatic to the skin as an extrammamary Paget's disease. Diagn Pathol 2012; 7:106. [PMID: 22901743 PMCID: PMC3502359 DOI: 10.1186/1746-1596-7-106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 07/31/2012] [Indexed: 11/10/2022] Open
Abstract
AIM The current paper describes a case of prostatic adenocarcinoma metastatic to the skin presenting as an extrammamary Paget's disease, a very rare and poorly characterised morphological entity. We report a case of prostatic carcinoma metastatic to skin showing a pattern of extramammary Paget's disease which has not been clearly illustrated in the literature Case presentation: A 63 year-old man with prostatic adenocarcinoma developed cutaneous metastases after 16 years. The inguinal metastases were sessile and 'keratotic.' The tumour displayed solid, glandular areas as well as a polypoid region suggestive of extramammary Paget's disease were identified. DISCUSSION AND CONCLUSIONS We review the diagnostic criteria that have led to the correct histopathological diagnosis in this case. A differential diagnosis of the pagetoid spread in the skin and various forms of cutaneous metastases determined by a prostatic adenocarcinoma as well as the role of immunohistochemistry in establishing the prostatic origin are presented in the context of this case. Although, morphologically the cells presented in the skin deposits were not characteristic for adenocarcinoma of prostate, immunohistochemistry for PSA and PSAP suggested a prostatic origin. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1395450057455276.
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Affiliation(s)
- Eugen Bogdan Petcu
- Griffith University School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
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Kremer V, Kremer A, Baldwin K, Sirsi S, Rafiaa A. Metastatic Prostate Carcinoma Mimicking Primary Anal Cancer. Urology 2012; 79:e75-6. [DOI: 10.1016/j.urology.2011.09.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 09/20/2011] [Accepted: 09/20/2011] [Indexed: 11/22/2022]
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Davarci M, Gokce A, Guven EO, Yalcinkaya FR, Esen H, Sevinc A. Metastatic prostate adenocarcinoma presenting as supraclavicular lymphadenopathy: a report of two cases. Contemp Oncol (Pozn) 2012; 16:53-5. [PMID: 23788855 DOI: 10.5114/wo.2012.27337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 10/26/2011] [Accepted: 01/18/2012] [Indexed: 11/18/2022] Open
Abstract
Clinical examination is very important in the practice of medicine. In patients presenting with a supraclavicular mass, a number of diseases including cancer should be ruled out. Two patients who presented with a bulky left supraclavicular mass were evaluated. Their medical history revealed complaints attributed to lower urinary tract infection. We performed histopathological examination of the lymph nodes with radiological evaluation of the thorax and abdomen. The final diagnoses were prostate cancer in both patients. It should always be kept in mind that prostate cancer is the most frequent cancer in elderly men, and although very unusual, the presenting finding can be cervical or supraclavicular lymphadenopathy; thus clinicians should be aware of urological examinations in such cases.
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Abstract
The bone tissue is the most frequent site for prostate carcinoma metastasis. Nevertheless many other areas have also been described. Using Pubmed and Cochrane the most exhaustive research possible has been carried out to list these secondary prostate carcinoma lesions.
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Affiliation(s)
- T Lebret
- Service d'Urologie, Hôpital Foch, Faculté de médecine Paris-Ile-de-France-Ouest, UVSQ Hôpital Necker, France.
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López-Navarro N, López-Sánchez J, Pérez-Enríquez J, Bosch R, Herrera E. Metástasis cutáneas atípicas de adenocarcinoma mucinoso prostático con células en anillo de sello. Actas Dermo-Sifiliográficas 2009. [DOI: 10.1016/s0001-7310(09)70835-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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López-Navarro N, López-Sánchez J, Pérez-Enríquez J, Bosch R, Herrera E. Atypical Skin Metastases of Mucinous Adenocarcinoma of the Prostate With Signet Ring Cells. Actas Dermo-Sifiliográficas (English Edition) 2009. [DOI: 10.1016/s1578-2190(09)70078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Wang SQ, Mecca PS, Myskowski PL, Slovin SF. Scrotal and penile papules and plaques as the initial manifestation of a cutaneous metastasis of adenocarcinoma of the prostate: case report and review of the literature. J Cutan Pathol 2008; 35:681-4. [DOI: 10.1111/j.1600-0560.2007.00873.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Catherine Bailey
- Palliative Care, Hope Healthcare, Greenwich, Sydney, New South Wales, Australia
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Affiliation(s)
- Jashin J Wu
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
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17
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Bellman B, Grossman M, Spitz J. Prostate cancer metastatic to skin. J Eur Acad Dermatol Venereol 2006. [DOI: 10.1111/j.1468-3083.1995.tb00290.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Polligkeit J, Westendorff C, Kröber SM, Zerfowski M, Hoffmann J. Sensibilitätsstörung und pathologische Unterkieferfraktur als Erstsymptome bei metastasiertem Prostatakarzinom. ACTA ACUST UNITED AC 2006; 10:118-21. [PMID: 16496113 DOI: 10.1007/s10006-006-0672-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Distant metastases of solid tumors account for about 1% of all malign neoplasms. In about 30% of all patients who present with an oral metastasis, the distant primary tumour has not been diagnosed yet. CASE REPORT We report the case of a 71-year-old man who clinically demonstrated unilateral mental neuropathy as well as pathologic fracture of the mandible. Prostate carcinoma was identified as a primary tumor. Clinically, there was significant hypesthesia of the skin area innervated by the left inferior alveolar nerve. X-ray examination revealed an osteolytic lesion of the ascending ramus of the mandible as well as a pathologic fracture of the mandible. Further imaging showed an extensive neoplasm of the mandible and adjacent soft tissues and significant supraclavicular lymph node enlargement. The diagnosis of metastatic carcinoma of the prostate was histopathologically confirmed. CONCLUSION Mental neuropathy without a dental focus indicates screening for an osseous metastasis. In cases of left-sided supraclavicular lymph node enlargement in men over 45 years, metastatic prostate carcinoma must be excluded.
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Affiliation(s)
- J Polligkeit
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Tübingen, Tübingen.
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Mueller TJ, Wu H, Greenberg RE, Hudes G, Topham N, Lessin SR, Uzzo RG. Cutaneous metastases from genitourinary malignancies. Urology 2004; 63:1021-6. [PMID: 15183939 DOI: 10.1016/j.urology.2004.01.014] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2003] [Accepted: 01/08/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To review the world literature for reports of cutaneous metastases from primary genitourinary malignancies and compare them with our experience during a 10-year period. Cutaneous metastases from primary visceral malignancies are uncommon manifestations of advanced disease. Among patients with urologic malignancies, the incidence and appearance of cutaneous metastases are not well established and recognition is poor among practicing urologists. METHODS A Medline search and manual bibliographic review was performed to identify peer-reviewed reports pertaining to cutaneous metastases from all visceral malignancies. A comparative review of all pertinent cases arising from primary urologic malignancies was performed. A comprehensive search of our institution's tumor registry was performed to identify all analytic cases of urologic malignancy diagnosed, treated, and followed up between 1990 and 2000. Clinical and pathologic data were collated. RESULTS We identified 2,369 reported cases of cutaneous metastases arising from 81,618 primary solid visceral malignancies, for an overall incidence of 2.9%. Dermatologic spread from primary urologic malignancies of the kidney, bladder, prostate, or testes was noted in 116 (1.3%) of 10,417. The incidence of cutaneous metastases from the kidney, bladder, prostate, and testes was 3.4%, 0.84%, 0.36%, and 0.4%, respectively. Overall, 436 cases of cutaneous metastases from urologic organs were identified in the English-language literature. We identified nine additional cases of pathologically confirmed cutaneous metastatic urologic tumors at our institution in the past 10 years. The most common presentation was an infiltrated plaque or nodules. Most cases displayed clinical features that mimicked common skin disorders. The median disease-specific survival was less than 6 months from the presentation of cutaneous metastasis. CONCLUSIONS Cutaneous metastases from urologic tumors are uncommon and occur in 1% of patients with advanced disease. Urologic skin metastases are most common from renal tumors, followed by those of the bladder and then prostate. Their clinical appearance may mimic other common dermatologic disorders affecting patients with advanced malignancies. Definitive diagnosis requires an index of suspicion and skin biopsy. Cutaneous metastases from urologic malignancies are associated with a poor prognosis.
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Affiliation(s)
- Thomas J Mueller
- Department of Urological Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
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de Diego Rodríguez E, del Valle Schaan JI, Gutiérrez Baños JL, Martín García B, Hernández Rodríguez R, Portillo Martín JA, Correas Gómez MA, Roca Edreira A, Villanueva Peña A, Rado Velázquez MA, Hernández Rodríguez A. [Massive lymphatic involvement secondary to prostatic adenocarcinoma]. Actas Urol Esp 2000; 24:836-9. [PMID: 11199304 DOI: 10.1016/s0210-4806(00)72558-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Prostatic carcinoma may be diagnosed by the clinic manifestations or by the symptoms for locoregional disemination and distance metastasis. The lymphatic system is the first metastatic station, which is affected in a high percentage of cases. Event it may simulate lymphoproliferatives process and it si uncommon the lymphatic macroaffectation at first. In theses cases, the histologic and immunohistochemical study by the determination of prostatic specific antigen in lymph nodes can provice the diagnosis. Treatment of these tumors is palliative with hormonotherapy. Prognosis is bad with a low survival at five years.
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Affiliation(s)
- E de Diego Rodríguez
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria
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Abstract
Malignant pleural effusions due to prostatic carcinoma are rare. We examined the cytologic and clinical presentations of 14 malignant pleural effusions caused by prostate cancer. These cases represented 2.3% of all positive pleural effusions at our institution. All patients (n = 10) had high grade, high stage tumors, including three with small cell anaplastic carcinoma. Three cases had clinically documented metastases to pleura, and in two cases, metastases were documented at autopsy. Most tumor cells had large nucleoli and were arranged in small, loosely cohesive groups. Fluids due to the small cell type of prostate carcinoma often contained a mixture of cells similar to those seen in small cell carcinoma of other sites such as the lung, as well as cells resembling the more typical type of prostate cancer. Prostatic specific antigen and prostatic acid phosphatase were positive in less than 50% of these malignant effusions. We conclude that prostatic carcinoma in pleural effusions occurs most commonly in high grade, high stage tumors and has a characteristic cytologic appearance. Negative staining for PSA and PAP does not rule out a prostatic source for malignant cells in effusions.
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Affiliation(s)
- A A Renshaw
- Department of Pathology, Brigham & Women's Hospital, Boston, MA 02115, USA
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22
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Abstract
Cutaneous metastasis from carcinoma of the prostate is a rare phenomenon. When it occurs, metastases usually appear as multiple nodules involving the suprapubic area and the anterior aspect of the thighs. We report on two cases of cutaneous metastases from prostatic carcinoma, one of them presenting the stereotypical clinical and histopathological findings, whereas in the other one cutaneous metastasis consisted of a morphea-like plaque on the chest. Histopathologically, the later case revealed accumulations of neoplastic cells distributed in a folliculotropic pattern. In both examples immunohistochemical study with prostatic specific antigen (PSA) confirmed the prostatic origin of the metastases. We review the literature on this subject.
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Affiliation(s)
- E Piqué Duran
- Department of Dermatology, Fundación Jiménez Díaz, Madrid, Spain
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23
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Abstract
The relative frequencies of cutaneous metastases are similar to those of the primary cancers; breast, colon, and melanoma are the most frequent in women and lung, colon, and melanoma are the most common in men. Cutaneous metastases represent an opportunity to detect a potentially treatable cancer before other evidence of it is present, to modify therapy as appropriate to the tumor stage, or possibly to use the cutaneous lesion as a source of easily accessible tumor cells for specific therapy. Cutaneous metastatic disease as the first sign of internal cancer is most commonly seen with cancer of the lung, kidney, and ovary.
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Affiliation(s)
- R A Schwartz
- New Jersey Medical School, Newark 07103-2714, USA
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24
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Affiliation(s)
- V Steinkraus
- Department of Dermatology, University of Hamburg, Germany
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25
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Nazzari G, Drago F, Malatto M, Crovato F. Epidermoid anal canal carcinoma metastatic to the skin. A clinical mimic of prostate adenocarcinoma metastases. J Dermatol Surg Oncol 1994; 20:765-6. [PMID: 7962940 DOI: 10.1111/j.1524-4725.1994.tb03202.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND. Cancers of the anal canal are rare, but their frequency is constantly increasing. Only 10-20% of the patients develop a local recurrence and about 20% distant visceral metastases. OBJECTIVE. To report what we believe to be the first case of skin metastases of epidermoid anal canal carcinoma mimicking a typical clinical pattern of prostatic adenocarcinoma metastases.
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Affiliation(s)
- G Nazzari
- Division of Dermatology, Chiavari Hospital, Genoa, Italy
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26
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Abstract
A case of scrotal and penile extramammary Paget's disease (EMPD) and concurrent prostate adenocarcinoma in a 59-year-old patient is presented. Immunohistochemically, the tumor cells of both the EMPD and prostate stained positively for prostate-specific antigen. Six previously reported cases of EMPD associated with prostate adenocarcinoma are reviewed, along with a discussion of current theories of the pathogenesis of EMPD.
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Affiliation(s)
- J P Sleater
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, Gainesville 32610
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27
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Abstract
Prostatic carcinoma rarely metastasizes to the skin. We describe a case in which inguinal metastasis occurred. Histologically, the tumor was composed of pale-staining cells which had pronounced epidermotropism, producing a pagetoid pattern mimicking that seen in malignant melanoma. The diagnosis was confirmed by demonstrating prostatic specific antigen in tumor cells.
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Affiliation(s)
- R Segal
- Division of Dermatology, Saint Louis University School of Medicine, MO 63104
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28
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Abstract
An incarcerated hernia containing peritoneal secondaries from carcinoma of the prostate is presented. Abdominal carcinomatosis may be due to a prostatic primary and will benefit from hormonal treatment.
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Affiliation(s)
- A Houghton
- Department of Surgery, Greenwich District Hospital, London, United Kingdom
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29
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Abstract
The skin is involved in metastases from 2-9% of malignant tumors. These usually tend to spread to the skin relatively late in the course of the disease. Skin metastases of prostatic origin are quite uncommon and preferentially localized to the lower abdomen and genital area. We present a case of cutaneous metastasis from prostatic adenocarcinoma that preceded diagnosis of the primary tumor and was located on the neck.
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Affiliation(s)
- J M Azaña
- Dermatology Department, Hospital Ramón y Cajal, Spain
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Abstract
BACKGROUND Splenic metastasis is uncommon and usually occurs in the setting of widespread visceral metastasis. Splenic metastasis as an initial manifestation of disease and sole site of metastasis has not been reported previously. METHODS The authors describe a patient with hairy cell leukemia (HCL) with the unexpected finding of metastatic adenocarcinoma in the spleen. Direct inspection at the time of laparotomy and subsequent radiographic studies did not show a primary or additional metastatic tumor. Eventually, he manifested evidence of pulmonary and hepatic metastases and died with fungal sepsis. RESULTS The splenectomy specimen showed HCL and metastatic adenocarcinoma. Immunohistochemical studies showed adenocarcinoma with diffuse cytoplasmic staining for prostate-specific antigen and focally positive results with prostatic acid phosphatase antigen. Postmortem examination 9 months later showed HCL and widespread metastatic adenocarcinoma. No primary tumor was identified, and multiple tissue blocks of the prostate had negative findings for tumor. CONCLUSIONS The immunohistologic features of the metastatic adenocarcinoma were interpreted as prostatic in origin. The pattern of isolated metastatic disease in the absence of primary tumor appears to represent another possible atypical disease presentation of prostatic cancer. Hairy cell-induced structural and immunologic alterations within the splenic microenvironment may have contributed to this unique clinical presentation.
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Affiliation(s)
- R W Sharpe
- Department of Laboratory Medicine, Naval Hospital of San Diego, California 92134-5000
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31
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Abstract
Extramammary Paget carcinoma (EPC) is considered to originate from the eccrine and apocrine glands of the adnexal skin of the axilla, vulva or penis, scrotum, or perineum. If immunohistochemical techniques with the use of cytoskeletal markers are applied in addition to histologic examination, EPC lesions are found to be multifocal adenocarcinoma of the adnexal sweat glands. So far, therapeutic approaches have included primary surgery, followed optionally by radiation therapy. It is possible to achieve a cure only when manifestations are detected early and confined regionally. The role of palliative chemotherapy has not yet been assessed in this disease, particularly because of the lack of compliance and follow-up in patients with EPC.
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Affiliation(s)
- H Voigt
- Department of Dermatological Oncology, St. Bernhard-Hospital, Kamp-Lintfort, Germany
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Abstract
BACKGROUND Disseminated intravascular coagulation (DIC) and primary fibrinolysis have both been reported in association with prostate carcinoma. The correct diagnosis of the coagulopathy can be difficult and the appropriate management controversial. METHODS A case is presented of a man in whom DIC and soft tissue hemorrhage developed after prostatic biopsy. The results of therapy and a review of the literature are discussed. RESULTS Fibrinogen levels continued to decrease despite high-dose estrogen therapy, but they rapidly returned to normal after therapy with epsilon-aminocaproic acid. Although routine coagulation tests were suggestive of primary fibrinolysis, the results of the D-dimer assay confirmed that the patient had DIC associated with excessive fibrinolysis. CONCLUSION A review of the literature suggests that most cases of primary fibrinolysis are probably DIC with excessive secondary fibrinolysis. In cases in which bleeding is the primary manifestation of DIC and there is a significant reduction in alpha-2-plasmin inhibitor activity, a trial of epsilon-aminocaproic acid and low-dose heparin should be considered. The failure in this case of estrogen therapy to correct the coagulopathy, despite a later good tumor response, is consistent with the delay in which anorchid testosterone levels are obtained after initiating treatment.
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Affiliation(s)
- D L Cooper
- Department of Internal Medicine, Yale University, School of Medicine, New Haven, Connecticut 06510
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33
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Abstract
We report an unusual supraglottic carcinoma metastasis to the penis. Review of the literature revealed more than 300 cases of metastatic lesions to the penis, excluding primary neoplasms from skin, urethra and blood. Of these metastatic neoplasms 16 originated above the diaphragm, only 4 of which were from the head and neck region. The most common neoplastic metastases to the penis in order of frequency were from the bladder, prostate, rectum and rectosigmoid areas, and kidney in 32, 30, 13 and 8% of the cases, respectively. The incidence of other primary tumor sites that metastasize to the penis is extremely rare.
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Affiliation(s)
- L M Perez
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710
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34
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Affiliation(s)
- R B Rossetti
- Department of Dermatology, Faculdade de Medicina, F.U.ABC, São Paulo, Brazil
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35
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Affiliation(s)
- F J Allen
- Department of Urology, University of Stellenbosch, Tygerberg, South Africa
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36
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Abstract
Metastatic involvement of the larynx by carcinoma of the prostate is a rare event: only 5 cases are recorded in the English literature. We report a case of prostatic carcinoma with symptomatic metastasis to the right vocal cord. Five months after the diagnosis of metastatic disease in the vocal cord the patient died of widespread metastases. We report the sixth case of this event and review the reported cases in the literature.
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Affiliation(s)
- D J Grignon
- Department of Pathology, University of Texas M.D. Anderson Hospital, Houston
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37
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Abstract
Priapism occurred in ten patients undergoing treatment of depression with trazodone or impotence with papaverine. Trazodone-related priapism uniformly required surgical procedures and resulted in impotence in two of three cases. In contrast, papaverine-associated priapism was successfully managed by aspiration and all seven patients continued to respond to intracorporal treatment. Iatrogenic priapism is an important complication of therapy with vasoactive drugs.
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Affiliation(s)
- E D Bardin
- Department of Urology, University of Washington, School of Medicine, Seattle
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38
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Abstract
Three cases of Paget's disease primarily involving the scrotum are reported. One case exhibited positive staining for prostate specific antigen (PSA) and was associated with an underlying, invasive poorly differentiated adenocarcinoma of unknown primary. The other cases were not associated with any underlying or visceral malignancy. The literature on Paget's disease primarily involving the scrotum including clinical presentation, differential diagnosis, treatment, prognosis, and possible histogenetic mechanisms of this disease is discussed.
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Affiliation(s)
- M A Perez
- Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia
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39
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40
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Affiliation(s)
- J L Ware
- Department of Surgery, Duke University Medical Center, Durham, NC
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41
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Abstract
A man aged 77 presented with nodules on the glans penis. Histological examination confirmed the diagnosis of metastases of prostatic carcinoma.
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42
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Abstract
Twenty-eight pretreatment and posttreatment biopsies from 11 cases of prostatic adenocarcinoma were stained for prostate-specific acid phosphatase (PAP), prostate-specific antigen (PSA), and keratin to determine the effect of hormonal (diethylstilbestrol) therapy on these immunological markers. Treatment intervals ranged from 2 to 63 months. All pretreatment tumors were strongly positive for PAP, and nine were strongly positive for PSA. Two were weakly positive for PSA, and all were negative for keratin. In five of the 11 posttreatment group cases, staining with both PAP and PSA was reduced. In three posttreatment cases, the malignant epithelium showed a squamoid appearance, and in these areas the keratin gave a positive reaction. These findings indicate that immunohistochemical staining with PAP and PSA may change in response to hormonal therapy. These alterations may lead to false-negative results when using these techniques to identify the primary tumor source of metastatic deposits of prostatic carcinoma.
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