Andrews Jack R, Ahmed Mohamed E, Motterle Giovanni, Albadri Sam T, Haloi Rimki, Karnes R Jeffrey, Kwon Eugene D, Price Katharine A
Department of Urology, Mayo Clinic, Rochester, MN.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
Mayo Clin Proc Innov Qual Outcomes. 2020 Aug 19;4(5):601-607. doi: 10.1016/j.mayocpiqo.2020.05.004. eCollection 2020 Oct.
A 62-year-old man presented with a rising serum concentration of prostate-specific antigen (PSA) to 53.3 ng/mL (to convert to μg/L, multiply by 1) and a PSA doubling time of 2.6 months. Computed tomography, fluorodeoxyglucose-positron emission tomography, and C-11 choline positron emission tomography demonstrated a parotid mass with innumerable lytic bone lesions and diffuse metastatic disease to the neck and mediastinal lymph nodes. Mediastinal lymph node biopsy revealed salivary ductal adenocarcinoma that produced PSA and demonstrated androgen receptor sensitivity. The patient had a prolonged clinical benefit to first- and second-line hormone therapy, and his PSA levels correlated with treatment response, development of hormone resistance, and progression. In summary, urologists, pathologists, and primary care providers should be aware that a rising PSA level in the setting of a head and neck mass in a patient without a history of prostate cancer does not constitute a diagnosis of metastatic prostate adenocarcinoma and that other primary tumors should be considered and a broader imaging and pathologic evaluation is indicated.
一名62岁男性患者，血清前列腺特异性抗原（PSA）浓度升至53.3 ng/mL（换算为μg/L时，乘以1），PSA倍增时间为2.6个月。计算机断层扫描、氟脱氧葡萄糖-正电子发射断层扫描和C-11胆碱正电子发射断层扫描显示腮腺肿块伴有无数溶骨性骨病变，并伴有颈部和纵隔淋巴结弥漫性转移。纵隔淋巴结活检显示为产生PSA并具有雄激素受体敏感性的涎腺导管腺癌。该患者对一线和二线激素治疗有较长时间的临床获益，其PSA水平与治疗反应、激素抵抗的发生及疾病进展相关。总之，泌尿外科医生、病理科医生和初级保健提供者应意识到，在无前列腺癌病史的患者中，出现头颈部肿块且PSA水平升高并不构成转移性前列腺腺癌的诊断，应考虑其他原发性肿瘤，并进行更广泛的影像学和病理学评估。
