Oyan Basak, Engin Huseyin, Yalcin Suayib
Department of Medical Oncology, Hacettepe University, Faculty of Medicine, Institute of Oncology, Sihhiye, Ankara, Turkey.
Med Oncol. 2002;19(3):177-9. doi: 10.1385/MO:19:3:177.
Prostate cancer most often metastases to regional lymph nodes and bones by hematogenous or lymphatic spread. Metastases to the supradiaphragmatic nodes are rare. A 56-yr-old male smoker with generalized lymphadenopathy was referred to our center with the complaints of weight loss of 15 kg and severe back and leg pain. On computed tomography of the thorax and abdomen, massive mediastinal, intra-abdominal, retroperitoneal, and inguinal lymphadenopathies with hydroureteronephrosis of the left kidney were noted. Excisional biopsy of left cervical lymph node revealed metastasis of prostatic adenocarcinoma and transrectal biopsy of the prostate disclosed poorly differentiated adenocarcinoma. Bone marrow aspiration biopsy, done for the differential diagnosis of anemia, also showed infiltration with prostate-specific antigen positive neoplastic cells. Supradiaphragmatic spread of prostate cancer has been postulated to be by a hematogenous route via the vertebral venous system, or Batson's plexus, accessible via direct extension from the primary cancer site.
前列腺癌最常通过血行或淋巴扩散转移至区域淋巴结和骨骼。转移至膈上淋巴结的情况罕见。一名56岁的男性吸烟者，有全身淋巴结肿大，因体重减轻15公斤以及严重的背部和腿部疼痛前来我院就诊。胸部和腹部计算机断层扫描显示，存在大量纵隔、腹腔内、腹膜后和腹股沟淋巴结肿大，同时左肾伴有输尿管肾盂积水。左颈部淋巴结切除活检显示前列腺腺癌转移，经直肠前列腺活检显示为低分化腺癌。为鉴别贫血而进行的骨髓穿刺活检也显示有前列腺特异性抗原阳性肿瘤细胞浸润。前列腺癌的膈上扩散被推测是通过血行途径，经椎静脉系统或巴特森静脉丛，该途径可通过原发癌部位的直接蔓延而进入。
