Tohfe Moustapha, Baki Samah Abdel, Saliba Wissam, Ghandour Fatmeh, Ashou Raja, Ghazal Georges, Bahous Joudy, Chamseddine Nabil
Hematology-Oncology Division, Faculty of Medicine University of Balamand, Saint George university Hospital, Beirut, Lebanon.
Cases J. 2008 Nov 17;1(1):316. doi: 10.1186/1757-1626-1-316.
Prostate cancer has a high tendency to spread to bone. Pulmonary metastasis and generalized lymphadenopathy commonly develop after pelvic and bone involvement have already occurred. Few patients with prostate cancer present initially with symptomatic metastatic lung lesions and lymphadenopathy without any other concomitant distant dissemination.
We report a case of a 73-year-old white male who sought medical help for symptoms of cough, hemoptysis, and dyspnea. A chest X-ray was done revealing multiple "cannon ball" infiltrates involving all segments of the lung parenchyma. Fine-needle aspiration cytology under computed tomography guidance of a subpleural lesion revealed adenocarcinomatous cells. Despite the absence of any detectable osseous lesions and with the presence of multiple hilar, mediastinal, para-aortic, and pelvic lymphadenopathy, the patient had a complete work-up in search for the primary adenocarcinoma. His prostate specific antigen was 146 ng/ml and a prostatic biopsy done, revealing an acinar prostatic adenocarcinoma. A tru-cut biopsy of a lung lesion under computed tomography guidance showed a metastatic prostatic adenocarcinoma positive for prostate specific antigen stain.
This case sheds light on an unusual metastatic pattern of prostatic adenocarcinoma. It also emphasizes the importance of including prostate cancer in the differential diagnosis of men with adenocarcinoma of unknown origin.
前列腺癌极易发生骨转移。在盆腔和骨骼受累后，常出现肺转移和全身淋巴结肿大。很少有前列腺癌患者最初表现为有症状的转移性肺部病变和淋巴结肿大，而无任何其他伴随的远处转移。
我们报告一例73岁白人男性，因咳嗽、咯血和呼吸困难症状寻求医疗帮助。胸部X线检查显示多个“炮弹样”浸润影累及肺实质的所有肺段。在计算机断层扫描引导下对胸膜下病变进行细针穿刺细胞学检查，发现腺癌细胞。尽管未发现任何可检测到的骨病变，且存在多个肺门、纵隔、主动脉旁和盆腔淋巴结肿大，但患者仍进行了全面检查以寻找原发性腺癌。他的前列腺特异性抗原为146 ng/ml，进行了前列腺活检，结果显示为腺泡状前列腺腺癌。在计算机断层扫描引导下对肺部病变进行切割活检，显示转移性前列腺腺癌前列腺特异性抗原染色呈阳性。
该病例揭示了前列腺腺癌一种不寻常的转移模式。它还强调了在不明来源腺癌男性患者的鉴别诊断中纳入前列腺癌的重要性。
