Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
Spinal Cord Ser Cases. 2020 Apr 22;6(1):25. doi: 10.1038/s41394-020-0276-7.
Skeletal metastases of advanced prostatic cancer are usually osteoblastic in appearance. Osteolytic secondaries are an uncommon entity. In such scenarios, it is important to differentiate prostatic metastases from other pathologies which give an identical radiological appearance, such as multiple myeloma. Another important point to remember is that neurological complications secondary to prostatic metastases are quite uncommon.
We describe a man with advanced prostatic carcinoma who presented to us with an uncommon combination of sudden onset complete paraplegia associated with diminished sensation in the lower half of the body and diffuse osteolytic lesions in the entire skeletal system. On detailed workup, it was found that his prostatic specific antigen (PSA) was grossly elevated. Markers for multiple myeloma were negative. Accordingly, computerized tomography of the abdomen was performed. The latter revealed an enlarged prostate gland infiltrating into the bladder base. Histopathological analysis from the prostate as well as the bone marrow showed an identical picture thereby confirming our diagnosis. The individual underwent palliative spinal canal decompression following which he was put on anti-androgenic treatment. At one year follow up, he was ambulatory and able to walk with use of crutches.
To the best of our knowledge, this is the first reported case of osteolytic prostatic metastases presenting as complete paraplegia. In this situation, in addition to evaluation for prostate CA, we also recommend screening for multiple myeloma as the clinico-radiological profile of the two diseases are similar but their management is very different.
晚期前列腺癌的骨骼转移通常表现为成骨样。溶骨性转移是一种罕见的实体。在这种情况下，重要的是要将前列腺转移与其他具有相同影像学表现的病变区分开来，例如多发性骨髓瘤。另一个需要记住的要点是，前列腺转移引起的神经并发症相当罕见。
我们描述了一名患有晚期前列腺癌的男性，他突然出现完全性截瘫，伴有下肢感觉减退和整个骨骼系统弥漫性溶骨性病变。详细检查后发现，他的前列腺特异性抗原（PSA）显著升高。多发性骨髓瘤标志物为阴性。因此，对腹部进行了计算机断层扫描。结果显示前列腺增大，浸润膀胱底部。前列腺和骨髓的组织病理学分析显示出相同的图像，从而证实了我们的诊断。该患者接受了姑息性椎管减压术，随后接受了抗雄激素治疗。一年后随访时，他可以使用拐杖行走。
据我们所知，这是首例溶骨性前列腺转移表现为完全性截瘫的病例报告。在这种情况下，除了评估前列腺癌外，我们还建议筛查多发性骨髓瘤，因为这两种疾病的临床-影像学特征相似，但治疗方法却大不相同。
