Mahjoubi Zied, Bibi Mokhtar, Hedhli Houssem, Ouanes Yassine, Rhouma Sami Ben, Yassine Nouira
Department of Urology, Hospital La Rabta, 1007, Tunis, Tunisia.
Department of Urology, Hospital La Rabta, 1007, Tunis, Tunisia.
Int J Surg Case Rep. 2020;77:483-485. doi: 10.1016/j.ijscr.2020.11.042. Epub 2020 Nov 11.
Metastatic prostate cancer is a relatively common condition in elderly men. The aim of this paper is to report a rare case of metastatic prostate cancer presenting as a large pelvic mass mimicking lymphoma and to discuss its management.
An 85-year-old patient was complaining of lower urinary tract symptoms, and significant pelvic swelling. On physical examination, a 15-cm pelvic mass and lumpy prostate were found. Laboratory investigations revealed elevated PSA levels (PSA=300g/mL). CT scan showed a large lobulated necrotic pelvic mass and multiple swollen lymphnodes. The diagnosis of an atypical pelvic lymphoma associated with a metastatic prostate cancer was first evoked. An ultrasonography-guided biopsy of the mass was carried. The immunohistochemical study confirmed prostate adenocarcinoma. A bilateral orchiectomy was performed. A follow up of 3 months showed a decrease of PSA without shrinkage of the mass.
A metastatic prostate cancer presenting as a compressive pelvic mass mimicking other diagnosis such as lymphomas, is a rare circumstance of discovery. In our case, atypical pelvic lymphoma was evoked based on the association of multiple retroperitoneal enlarged lymphnodes. Histological findings of the biopsy rectified the diagnosis and confirmed prostate adenocarcinoma. The main treatment for such metastatic prostate cancers remains hormone therapy. Some authors reported external beam radiotherapy in order to reduce prostate volume.
Prostate cancer should be considered in the assessment of large pelvic masses. Digital rectal examination and testing PSA levels can lead to the diagnosis. After histological confirmation, the androgen deprivation is the main treatment.
转移性前列腺癌在老年男性中较为常见。本文旨在报告一例罕见的转移性前列腺癌病例，该病例表现为酷似淋巴瘤的盆腔巨大肿块，并讨论其治疗方法。
一名85岁患者主诉下尿路症状及明显的盆腔肿胀。体格检查发现一个15厘米的盆腔肿块和结节状前列腺。实验室检查显示前列腺特异性抗原（PSA）水平升高（PSA = 300μg/mL）。CT扫描显示一个大的分叶状坏死盆腔肿块及多个肿大淋巴结。最初考虑诊断为与转移性前列腺癌相关的非典型盆腔淋巴瘤。对肿块进行了超声引导下活检。免疫组化研究证实为前列腺腺癌。进行了双侧睾丸切除术。3个月的随访显示PSA下降，但肿块未缩小。
转移性前列腺癌表现为压迫性盆腔肿块并酷似其他诊断（如淋巴瘤）是一种罕见的发现情况。在我们的病例中，基于多个腹膜后肿大淋巴结的存在考虑了非典型盆腔淋巴瘤。活检的组织学结果纠正了诊断并证实为前列腺腺癌。此类转移性前列腺癌的主要治疗方法仍然是激素治疗。一些作者报告了外照射放疗以缩小前列腺体积。
在评估盆腔巨大肿块时应考虑前列腺癌。直肠指检和检测PSA水平可有助于诊断。组织学确诊后，雄激素剥夺是主要治疗方法。
