Rare presentation of a prostate cancer, case report

Maurizio Foresio1, Antonio Carrieri1, Angelo D'Elia1, Floriano Beleggia1
  • 1 Ospedale SS. Annunziata (Taranto)

Objective

The prognosis of prostate cancer mainly depends on the presence or absence of metastatic spread . Prostate cancer usually metastasises to the bony skeleton, followed by Liver 19.8%, Lung 13.1%, Peritoneum 3.6%, Adrenal 3%, brain/dura 3%
Most cases present with localized disease and have good prognosis. However, advanced metastatic prostate cancer commonly metastasizes to regional lymph nodes and vertebral bones, but metastasis lateral cervical lymph nodes is rare.
Important to recognize rare presentations metastatic disease, to obtain the correct diagnosis.
There are only 2 published cases

Materials and Methods

CLG 76 years-old, cardiopathy post-IMA , treaty with anticoagulants and antihypertensive drugs ,psa 178 ng/ml, palpable lateral cervical lymph nodes (LLC). T ac total negative body except for 4 lymph nodes Lc . Therefore, the patient undergoes at the department of otolaryngology Taranto to resection of adenopathy. Histology was suggestive of positive adenocarcinomatoide infiltrated with immunohistochemical markers, (cytokines) CK8 and CK18. Therefore, the patient was sent to us for appropriate assessment. The patient after rectal examination, was performative a transrectal prostate biopsy, under local anesthesia
They are executed only 4 needles for no patient compliance and its upward pressure until 190/85 mm / HGG and 108 bpm

Results

The survey showed a clinical t2A, the biopsy Gleason 4 + 4 and 50 % of positive cores (those on the left). Scintigraphy t / B positive for secondarità 2 of radiopharmaceutical accumulation in the iliac crests
The patient, now has been put into bat ( bicalutamide + three-month Leuprorelina Acetato ) and if it evaluates the answer.

Discussions

Lymphnodes are commonly involved during the course of metastatic prostate cancer. Hypogastric and
obturator lymph nodes as the most common sites.
This case reported, wanted examineted a atypical prostate cancer metastases cases. The
awareness of the manifestations of prostate cancer metastases may enable accurate diagnosis,
staging and help in appropriate management of disease. direct us to the correct diagnosis markers such as cytokines , that we used in this case. Cytokines CK8, CK18, are useful screening markers for the recognition of epithelial differentiation.( 9)
PanCKC (CK8/CK18/CK19) representing
epithelial cells. CK18, are also positively expressed by lung adenocarcinoma,
colorectal cancer (CRC), and prostate cancer (10)
Finally, in the case of prostate cancer, we combined PSA, because in the clinical application, immunohistochemistry for PSA is commonly used for In the diagnosis of
prostate cancer (10).

Conclusion

Prostate cancer should be always considered in the differential diagnosis
of elderly men presenting with supraclavicular lymphadenopathy, hydroureteronephrosis
or later cervical lymphadenopathy even in the presence of a normal digital rectal. PSA immunohistochemical staining should be used in doubtful cases. Obviously, prevention has its importance.

Reference

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