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Ghosh B, Dorairajan LN, Kumar S, Basu D. Penile nodule with inguinal lymphadenopathy: Prostatic adenocarcinoma masquerading as penile cancer. Indian J Urol 2013; 29:56-8. [PMID: 23671367 PMCID: PMC3649602 DOI: 10.4103/0970-1591.109986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although anatomically the penis is closely related to the prostate, penile metastasis from prostate cancer is an uncommon phenomenon. These patients usually present late in the course of the disease with wide spread metastasis. We report a patient who presented with a penile mass and inguinal lymphadenopathy. He was clinically diagnosed as a case of penile cancer but the penile mass as well as the inguinal lymphadenopathy was subsequently diagnosed to be metastases from carcinoma of the prostate.
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Affiliation(s)
- Bastab Ghosh
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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52
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Upchurch EA, Khan F, Okeke A. Symptomatic bilateral testicular metastasis from carcinoma of the prostate. BMJ Case Rep 2013; 2013:bcr-2013-009008. [PMID: 23563685 DOI: 10.1136/bcr-2013-009008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A man in his late 70s, on hormonal treatment for prostatic adenocarcinoma, presented with bilateral enlarged and painful testes. Bilateral orchidectomy was undertaken and subsequent histological examination revealed both testes completely infiltrated with metastatic prostatic carcinoma.
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Affiliation(s)
- Emma Ann Upchurch
- Department of Upper GI Surgery, Gloucestershire Royal Hospital, Cheltenham, UK.
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53
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Messeguer F, Nagore-Enguídanos E, Requena C, Guillén-Barona C. An unusual presentation of penile metastasis from prostatic adenocarcinoma. Int J Dermatol 2012; 51:1133-4. [PMID: 22909372 DOI: 10.1111/j.1365-4632.2010.04733.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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54
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Mearini L, Colella R, Zucchi A, Nunzi E, Porrozzi C, Porena M. A review of penile metastasis. Oncol Rev 2012; 6:e10. [PMID: 25992200 PMCID: PMC4419641 DOI: 10.4081/oncol.2012.e10] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/02/2012] [Accepted: 06/07/2012] [Indexed: 12/16/2022] Open
Abstract
Penile cancer as primary disease is relatively rare in developed countries. The penis is a rare site of metastases in spite of its rich vascularization. Approximately 500 cases have been reported in the literature; almost 70% of primary lesions are of pelvic origin (from genitourinary or recto-sigmoid primary tumors). We describe a case of penile metastasis from lung cancer. The rarity of the event prompted us to also explore related reviews and discuss the incidence, physiopathology, diagnosis and therapy of penile secondary cancer.
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Affiliation(s)
| | - Renato Colella
- Pathological Anatomy and Histology Department, University of Perugia, Italy
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55
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Tarján M, Chen HH, Tot T, Wu W, Lenngren A, Dean PB, Tabár L. Improved differentiation between ductal and acinar prostate cancer using three-dimensional histology and biomarkers. ACTA ACUST UNITED AC 2012; 46:258-66. [PMID: 22519924 DOI: 10.3109/00365599.2012.675586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the study was to refine the methodology for discriminating the ductal (DAP) and acinar adenocarcinomas (AAP) of the prostate and confirm that prostate carcinoma of ductal origin is a more aggressive subtype. MATERIAL AND METHODS A retrospective analysis of 110 consecutive radical prostatectomy cases operated on between 2000 and 2006 and worked up using large-format "two-dimensional" (2D; 4 μm thick) and "three-dimensional" (3D; 1500 μm thick) histology sections was carried out, with an average follow-up of 5.1 years. The same material was also analysed for selected biomarkers in tissue microarray blocks. The most discriminatory biomarkers were then tested on preoperative core biopsy specimens from 24 of these patients. RESULTS 3D histology classified 97/110 (88%) cases of AAP and 13/110 (12%) DAP, which was then confirmed in 2D specimens. The DAP cases had a significantly greater frequency of pT3a and more advanced cancers, > 20 mm tumour focus, high-grade prostatic intraepithelial neoplasia, Gleason score ≥ 7, positive margin, extracapsular extension, vascular invasion, seminal vesicle infiltration, biochemical/local recurrence, regional lymph-node metastases and distant metastases. Three biomarkers in combination (chromogranin A, epidermal growth factor receptor and p53] distinguished DAP from AAP with an accuracy of 94% (area under the curve 0.94, 95% confidence interval 0.88-0.99). The same high accuracy was achieved using these three biomarkers on the preoperative specimens. CONCLUSIONS Both 3D histology and the three selected biomarkers can help in accurately distinguishing DAP from AAP. The clear-cut distinction of two forms of prostate cancers by the approach advocated in this paper would allow AAP patients to undergo less radical treatment and would segregate DAP patients into a subset requiring more effective treatment regimens.
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Affiliation(s)
- Miklós Tarján
- Department of Pathology and Clinical Cytology, Central Hospital, Falun, Sweden.
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56
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Nason GJ, O'Reilly MK, Long RM, Ingoldsby H, Barrett C, O'malley KJ. A presentation of glandular penile metastases from prostate adenocarcinoma. ACTA ACUST UNITED AC 2012; 46:306-9. [PMID: 22486259 DOI: 10.3109/00365599.2012.675587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Secondary tumours of the penis are rare; they most commonly arise from the prostate and the bladder. These lesions are often associated with disseminated malignancy and have a poor prognosis, with a 6-month mortality of up to 80% reported. Penile metastases have a variety of clinical manifestations including incidental penile nodules, cutaneous findings, urinary symptoms, pain and malignant priapism. Treatment options are mainly targeted at improving the patients' quality of life and are tailored to their clinical condition, but are primarily palliative. This study reports a case of a 92-year-old man with a presentation of glandular penile metastases from prostate adenocarcinoma treated conservatively.
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Affiliation(s)
- Gregory J Nason
- Department of Urology, Mater Misericordiae University Hospital, Dublin, Ireland.
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57
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Tarján M, Lenngren A, Hellberg D, Tot T. Immunohistochemical verification of ductal differentiation in prostate cancer. APMIS 2012; 120:510-8. [PMID: 22583364 DOI: 10.1111/j.1600-0463.2011.02862.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent studies have shown that patients with prostate carcinomas exhibiting ductal differentiation have an unfavourable prognosis compared with those with purely acinar adenocarcinomas. We studied the expression of nine immunohistochemical markers to evaluate their value in delineating carcinomas with and without ductal differentiation. Thirteen tumours showing cellular characteristics and growth patterns typical of ductal differentiation were identified among 110 analysed prostatectomy specimens. The levels of cytoplasmic expression of chromogranine A (69% vs 19%, p = 0.0003) and nuclear expression of p53 (76% vs 12%, p < 0.0001) as well as nuclear expression of Ki-67 (69% vs 26%, p = 0.0047) in the tumour cells, were found to be statistically significantly different in the two tumour categories. Assessment of chromogranine A, p53 and Ki-67 in prostate carcinoma may serve as useful adjunctive diagnostic tools for delineating more aggressive prostate cancer cases exhibiting ductal differentiation.
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Affiliation(s)
- Miklós Tarján
- Department of Pathology and Clinical Cytology, Central Hospital, Falun, Sweden.
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58
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59
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Sfoungaristos S, Katafigiotis IS, Tyritzis SI, Kavouras A, Kanatas P, Petas A. An 82-year-old Caucasian man with a ductal prostate adenocarcinoma with unusual cystoscopic appearance: a case report. J Med Case Rep 2011; 5:4. [PMID: 21223563 PMCID: PMC3024288 DOI: 10.1186/1752-1947-5-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 01/11/2011] [Indexed: 11/23/2022] Open
Abstract
Introduction Ductal adenocarcinoma is a rare variety of the common acinar adenocarcinoma. It usually presents with refractory symptoms, and during cystoscopy, it is seen as an exophytic lesion at the area of the verumontanum. Case presentation An 82-year-old Caucasian man was diagnosed with ductal adenocarcinoma of the prostate after undergoing transurethral resection of the prostate for urinary retention. Immunohistochemistry confirmed the nature of the tumor. The patient was treated with triptorelin, 3.75 mg once/month, and bicalutamide, 50 mg 1 × 1. The serum prostate-specific antigen at three, six and 12 months after transurethral resection of the prostate was 0.1 ng/ml. The patient remains asymptomatic, and he entered a six-month follow-up protocol. Conclusion Ductal adenocarcinoma often involves the central ducts of the gland and may present as an exophytic papillary lesion in the prostatic urethra. This is why it usually presents with refractory symptoms. The outcome for men with prostatic ductal adenocarcinoma is, in most studies, worse than the outcome for men with prostatic acinar adenocarcinoma. Aggressive management is indicated, even with low-volume metastatic disease.
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60
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Kwon SY, Jung HS, Lee JG, Choi SH, Kwon TG, Kim TH. Solitary testicular metastasis of prostate cancer mimicking primary testicular cancer. Korean J Urol 2011; 52:718-20. [PMID: 22087369 PMCID: PMC3212669 DOI: 10.4111/kju.2011.52.10.718] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 07/14/2011] [Indexed: 11/18/2022] Open
Abstract
We report a rare case of testicular metastasis from prostate cancer. A 68-year-old patient presented with a right testicular mass with discomfort. He had a history of robot-assisted laparoscopic radical prostatectomy and had received adjuvant radiation therapy and had been treated with androgen deprivation therapy continuously at another institution. We performed a right inguinal orchiectomy. The testicular mass was diagnosed as a metastasis from prostate carcinoma.
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Affiliation(s)
- Se Yun Kwon
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
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61
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Meeks JJ, Zhao LC, Cashy J, Kundu S. Incidence and outcomes of ductal carcinoma of the prostate in the USA: analysis of data from the Surveillance, Epidemiology, and End Results program. BJU Int 2011; 109:831-4. [PMID: 21883856 DOI: 10.1111/j.1464-410x.2011.10520.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To use the national Surveillance, Epidemiology, and End Results (SEER) cancer registry to describe the natural history, national incidence and treatment patterns for ductal prostate cancer (PCa) over the last 20 years, as the available literature on ductal PCa is limited to small case series because of few patient numbers. PATIENTS AND METHODS From the SEER registry, 693 men with ductal PCa were identified from 1970. The demographics, clinical features and cause of death data were collected from men with ductal and acinar histological types. RESULTS The incidence of ductal PCa has increased over each decade, but the overall percentage of ductal relative to acinar PCa has remained stable. Men with ductal PCa were more likely to present with advanced disease (30% T3 with ductal PCa, compared with 7% with acinar PCa). Men with ductal PCa underwent similar rates of radical surgery, lower rates of radiotherapy but a higher frequency of outlet (transurethral resection) procedures. Men with ductal PCa had a significantly greater rate of death from PCa (12% vs 4%) than men with acinar PCa. Comparing PCa-specific mortality, men with ductal PCa had similar rates of death to men with Gleason 4 + 4 grade acinar PCa. CONCLUSIONS Despite a stable incidence, ductal PCa remains an aggressive PCa usually presenting with advanced clinical stage and resulting in a high rate of PCa-specific mortality similar to Gleason 4 + 4 acinar PCa. Patients would probably benefit from combined modalities including radical surgery, radiotherapy and palliative outlet procedures.
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Affiliation(s)
- Joshua J Meeks
- Northwestern University, Department of Urology, Chicago, IL, USA
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62
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Kumar A, Mukherjee SD. Metastatic ductal carcinoma of the prostate: a rare variant responding to a common treatment. Can Urol Assoc J 2011; 4:E50-4. [PMID: 20368883 DOI: 10.5489/cuaj.830] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ductal carcinoma of the prostate is a rare histologic subtype of prostate carcinoma. It represents 0.4% to 0.8% of all prostate cancers and is associated with a poor prognosis. Given the paucity of cases reported in the literature on ductal prostate carcinoma, little is known about how this cancer responds to cytotoxic chemotherapy. We report the case of a 56-year-old male who presented to our clinic with hemoptysis, cough and hematuria and was found to have metastatic ductal carcinoma of the prostate. He was initiated on docetaxel chemotherapy, which has been previously shown to improve overall survival in patients with metastatic prostate adenocarcinoma, but has never been studied in this less common subtype of prostate cancer. To the best of our knowledge, the following is the first reported case of a patient with metastatic ductal carcinoma of the prostate responding to docetaxel chemotherapy.
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Affiliation(s)
- Aalok Kumar
- Internal Medicine Resident, Post-Graduate Year 2, McMaster University, Hamilton, ON
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63
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Ductal adenocarcinoma of the prostate—reply. Hum Pathol 2011. [DOI: 10.1016/j.humpath.2010.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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64
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Abstract
Metastasis of prostate carcinoma to the testis is seldom reported. The tumour may spread from the prostatic urethra by retrograde venous extension, arterial embolism or through direct invasion into the lymphatics and lumen of the vas deferens. Clinical manifestations of secondary testicular tumours from the prostate are most often unsuspected clinically and are instead detected incidentally during orchidectomy. Less frequently, a palpable mass is detected, which may be confused with a primary testicular neoplasm. We report a case of a 66-year-old patient with adenocarcinoma of the prostate, and a left testicular tumour that was diagnosed as metastases from prostate carcinoma after radical orchidectomy.
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65
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Morgan TM, Welty CJ, Vakar-Lopez F, Lin DW, Wright JL. Ductal adenocarcinoma of the prostate: increased mortality risk and decreased serum prostate specific antigen. J Urol 2010; 184:2303-7. [PMID: 20952027 DOI: 10.1016/j.juro.2010.08.017] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The clinical significance of ductal prostatic carcinoma is not well-defined. In a population based cancer registry we identified a large group of patients with ductal carcinoma to characterize the impact of the ductal subtype on presentation and survival in men with prostate cancer. MATERIALS AND METHODS We used a national cancer registry to identify incident cases of ductal and acinar adenocarcinoma from 1996 to 2006. We analyzed clinicopathological variables and performed Cox multivariate survival analysis. Prostate specific antigen values were available for 2004 to 2006 and used to assess differences in Gleason grade and serum prostate specific antigen between ductal and acinar cancer cases at diagnosis. RESULTS We identified 442,881 acinar and 371 ductal cases. Ductal cases were more likely to present with distant disease (12% vs 4%, p <0.001) and be poorly differentiated (50% vs 32%, p <0.001). Ductal histology was associated with a 30% decrease in geometric mean prostate specific antigen (adjusted coefficient 0.7, 95% CI 0.6-0.8) and more than 2-fold increased odds of prostate specific antigen less than 4.0 ng/ml (OR 2.4, 95% CI 1.4-4.0) independent of other clinicopathological variables. In men with nondistant disease at diagnosis ductal histology was associated with 2.2-fold (CI 1.4-3.5) increased disease specific mortality. CONCLUSIONS In what is to our knowledge the largest series of this histological subtype ductal cancer cases were more likely to present with advanced stage cancer and lower prostate specific antigen, suggesting that timely disease detection is a significant challenge. Also, men with locoregional disease were more likely to die of the disease.
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Affiliation(s)
- Todd M Morgan
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee, USA
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66
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Samaratunga H, Duffy D, Yaxley J, Delahunt B. Any proportion of ductal adenocarcinoma in radical prostatectomy specimens predicts extraprostatic extension. Hum Pathol 2010; 41:281-5. [DOI: 10.1016/j.humpath.2009.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 08/12/2009] [Accepted: 08/17/2009] [Indexed: 10/20/2022]
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67
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Testicular Metastasis of Prostatic Cancer. Urology 2010; 75:249-50. [DOI: 10.1016/j.urology.2009.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 08/22/2009] [Accepted: 09/01/2009] [Indexed: 11/20/2022]
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68
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Subhawong AP, Subhawong TK, Li QK. Fine needle aspiration of metastatic prostate carcinoma simulating a primary adrenal cortical neoplasm: a case report and review of the literature. Diagn Cytopathol 2009; 38:147-53. [PMID: 19693937 DOI: 10.1002/dc.21165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Adrenal metastases usually occur in prostate cancer patients with widespread bone and visceral disease. Autopsy studies have shown that adrenal metastases may be found in up to 23% of these patients. However, the finding of an isolated adrenal metastasis without the involvement of other organs in a patient with prostate cancer is exceedingly rare. Thus, it may cause a diagnostic dilemma on FNA cytology. We report a patient with a history of prostate cancer, status post radiation, and hormonal therapy 4 years before, who presented with a new, single adrenal mass on abdominal imaging studies. The ultrasound-guided FNA cytology of the adrenal mass revealed cytomorphological features that were suggestive of a primary adrenal cortical neoplasm, but overlapped with those of a prostate metastasis. To our knowledge, FNA findings of metastatic prostate cancer simulating an adrenal cortical neoplasm have not been previously reported in the English literature. The purpose of our study is to discuss the differential diagnosis of these entities. The accurate diagnosis is important because of different prognosis and treatment implications for the various diseases.
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Affiliation(s)
- Andrea P Subhawong
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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69
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Tu SM, Lopez A, Leibovici D, Bilen MA, Evliyaoglu F, Aparicio A, Guo CC, Kuban DA, Johnson MM, Pisters LL. Ductal adenocarcinoma of the prostate: clinical features and implications after local therapy. Cancer 2009; 115:2872-80. [PMID: 19402048 DOI: 10.1002/cncr.24326] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ductal or endometrioid adenocarcinoma of the prostate may be a subtype of prostate cancer that is amenable to aggressive local therapeutic strategies. The authors of this report investigated the clinical outcome of patients who had prostate ductal adenocarcinoma after primary radical prostatectomy or radiotherapy. METHODS The clinical features of 108 patients with locally confined or advanced prostate ductal adenocarcinoma who had undergone primary radical prostatectomy (surgical group, n = 76 men) or no surgery (nonsurgical group, n = 32 men) were evaluated retrospectively. Clinical records were reviewed, and Gleason scores, clinical/pathologic stages, and preoperative prostate-specific antigen levels were examined. The clinical features that were assessed included local recurrence, distant metastasis, and progression-free and overall survival after primary therapy. RESULTS In the surgical group, patients who had pure ductal prostate cancer survived longer (median, 13.8 years; 95% confidence interval [CI], from 13.8 years to not attained) than patients who had mixed ductal prostate cancer (median, 8.9 years; 95% CI, from 7.1 years to not attained; P = .05). In addition, the median time to local progression was shorter (2.8 years vs 4.9 years) and the median time to distant metastasis was longer (3.9 years vs 2.0 years) for patients who had pure ductal adenocarcinoma than for patients who had mixed ductal adenocarcinoma of the prostate after surgery, respectively. CONCLUSIONS The results of this preliminary study suggested that pure ductal prostate adenocarcinoma tends to pursue an indolent clinical course and poses an increased risk for local recurrence. Local control (particularly prostatectomy) may improve the clinical outcome of patients with pure prostate ductal adenocarcinoma. These results need to be confirmed in prospective studies.
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Affiliation(s)
- Shi-Ming Tu
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Korkes F, Gasperini R, Korkes KL, Silva Neto DCV, Castro MG. Testicular metastases: a poor prognostic factor in patients with advanced prostate cancer. World J Urol 2008; 27:113-5. [DOI: 10.1007/s00345-008-0322-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022] Open
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71
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Chu K, Cheng CJ, Ye X, Lee YC, Zurita AJ, Chen DT, Yu-Lee LY, Zhang S, Yeh ET, Hu MCT, Logothetis CJ, Lin SH. Cadherin-11 promotes the metastasis of prostate cancer cells to bone. Mol Cancer Res 2008; 6:1259-67. [PMID: 18708358 PMCID: PMC2643879 DOI: 10.1158/1541-7786.mcr-08-0077] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Bone is the most common site of metastases from prostate cancer. The mechanism by which prostate cancer cells metastasize to bone is not fully understood, but interactions between prostate cancer cells and bone cells are thought to initiate the colonization of metastatic cells at that site. Here, we show that cadherin-11 (also known as osteoblast-cadherin) was highly expressed in prostate cancer cell line derived from bone metastases and had strong homophilic binding to recombinant cadherin-11 in vitro. Down-regulation of cadherin-11 in bone metastasis-derived PC3 cells with cadherin-11-specific short hairpin RNA (PC3-shCad-11) significantly decreased the adhesion of those cells to cadherin-11 in vitro. In a mouse model of metastasis, intracardiac injection of PC3 cells led to metastasis of those cells to bone. However, the incidence of PC3 metastasis to bone in this model was reduced greatly when the expression of cadherin-11 by those cells was silenced. The clinical relevance of cadherin-11 in prostate cancer metastases was further studied by examining the expression of cadherin-11 in human prostate cancer specimens. Cadherin-11 was not expressed by normal prostate epithelial cells but was detected in prostate cancer, with its expression increasing from primary to metastatic disease in lymph nodes and especially bone. Cadherin-11 expression was not detected in metastatic lesions that occur in other organs. Collectively, these findings suggest that cadherin-11 is involved in the metastasis of prostate cancer cells to bone.
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Affiliation(s)
- Khoi Chu
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
| | - Chien-Jui Cheng
- Department of Pathology, Taipei Medical University and Hospital, Taipei, Taiwan
| | - Xiangcang Ye
- Department of Molecular Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
| | - Yu-Chen Lee
- Department of Molecular Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
| | - Amado J. Zurita
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
| | - Dung-Tsa Chen
- Biostatistics Division, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida
| | - Li-Yuan Yu-Lee
- Department of Medicine, Baylor College of Medicine, Houston, Texas 77030
| | - Sui Zhang
- Department of Cardiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
| | - Edward T. Yeh
- Department of Cardiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
| | - Mickey C-T. Hu
- Department of Molecular and Cellular Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
| | - Christopher J. Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
| | - Sue-Hwa Lin
- Department of Molecular Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030
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72
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A case of prostatic adenocarcinoma recurrence presenting as ductal carcinoma of the prostate. NATURE CLINICAL PRACTICE. UROLOGY 2008; 5:55-8. [PMID: 18185514 DOI: 10.1038/ncpuro0994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2007] [Accepted: 09/10/2007] [Indexed: 11/08/2022]
Abstract
BACKGROUND A 61-year-old man with a history of recurrent prostate cancer presented with obstructive urinary symptoms. He had been diagnosed with locally invasive adenocarcinoma of the prostate 10 years previously and treated with neoadjuvant hormonal and external beam radiation therapies. Because of the patient's rising PSA level, he had been started on goserelin 6 years after this diagnosis and bicalutamide 6 months before the current presentation. The patient presented to the urology clinic with worsening lower urinary tract symptoms consisting of nocturia, urgency, and weak stream. INVESTIGATIONS Physical examination revealed a largely normal digital rectal examination, although there was slight asymmetry. The post-void residual urine volume was approximately 200 ml. Laboratory tests showed no evidence of urinary tract infection, but confirmed a rising PSA level despite low serum testosterone levels. Cystoscopic examination revealed hypervascular, large lateral prostatic lobes obstructing the bladder neck. The bladder was normal. DIAGNOSIS The patient underwent transurethral resection of the prostate. Soon after the resection started, bilateral papillary tumors arising from the stroma of both prostatic lobes were uncovered. Owing to the diffuse nature of the papillary tumors, complete resection was not possible. Pathologic analysis confirmed the presence of ductal carcinoma of the prostate. MANAGEMENT The patient had an uneventful postoperative course and reported improvement of voiding symptoms. Staging with bone scan and CT of the abdomen and pelvis demonstrated multi-focal bony metastasis. The patient was started on docetaxel-based chemotherapy for hormone refractory recurrence of prostate cancer as ductal carcinoma of the prostate. He remains under close surveillance for clinical response and progression of disease.
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73
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Eade TN, Al-Saleem T, Horwitz EM, Buyyounouski MK, Chen DY, Pollack A. Role of radiotherapy in ductal (endometrioid) carcinoma of the prostate. Cancer 2007; 109:2011-5. [PMID: 17420979 PMCID: PMC1950740 DOI: 10.1002/cncr.22644] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Ductal carcinoma of the prostate is a rare variant of prostate cancer that presents most commonly with obstructive urinary symptoms or hematuria. This case series of 6 patients is the first to report the outcome of ductal carcinoma treated with external beam radiotherapy. METHODS A retrospective review was performed of patients treated between 1980 and 2006 at Fox Chase Cancer Center, Philadelphia, Penn. Six patients were identified with ductal carcinoma. RESULTS Five of the 6 patients were treated definitively and the sixth patient was treated at recurrence 3 years after a radical prostatectomy. Patient ages ranged from 66-80 years and the initial prostate-specific antigen (iPSA) ranged from 1.69-100.3 ng/mL. Three patients had a mixed acinar and ductal carcinoma, 2 with a Gleason score (GS) of 8 and 1 with a GS of 7. Of the patients treated definitively, 4 had clinical stage T2A-T2C and 1 had clinical stage T1B. Definitive radiotherapy was delivered to the prostate with doses between 72 Gy and 78 Gy. Pelvic lymph nodes were treated in all patients. One patient was treated postradical prostatectomy to the prostate bed to a dose of 60 Gy. Adjuvant androgen deprivation was given in 5 of the patients. Two of the patients died from metastatic disease at 1.4 and 7.1 years after treatment. The remaining 4 patients remain alive between 3.2 and 4.8 years from treatment, with 3 patients biochemically without evidence of disease. No patients have developed a local recurrence. CONCLUSIONS Ductal carcinoma of the prostate may be treated effectively with external beam radiotherapy. Aggressive management is indicated, even with low-volume metastatic disease.
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Affiliation(s)
- Thomas N. Eade
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Tahseen Al-Saleem
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Eric M. Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Mark K. Buyyounouski
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - David Y.T. Chen
- Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Alan Pollack
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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74
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Cai T, Salvadori A, Nesi G, Detti B, Tinacci G, Zini E, Bartoletti R. Penile metastasis from a T1b prostate carcinoma. Oncol Res Treat 2007; 30:249-52. [PMID: 17460419 DOI: 10.1159/000100868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Penile metastasis from incidental prostate carcinoma has not been described to date. CASE REPORT The case of a 72-year-old man affected by penile metastasis from incidental prostate carcinoma is described. In March 1998, the patient underwent prostate surgery for lower urinary tract symptoms related to benign prostatic obstruction. Histological examination revealed an incidental adenocarcinoma of the prostate. The pre-operative prostate-specific antigen (PSA) value was 3.6 ng/ml. A prostate biopsy in the peripheral prostate lobes was negative. PSA progressively rose to 8 ng/ml. The prostate biopsy was repeated and was still negative. The patient was subjected to radiotherapy, as a result of which his PSA fell to 0.7 ng/ml. 4 years after prostatectomy, the PSA rose again and the patient underwent hormonal therapy. The PSA fell to < 0.001 ng/ml. In May 2004, the patient reported a painful, erythematous nodule on his penis glans. Surgical biopsy showed a metastasis from prostate adenocarcinoma and he underwent partial penectomy. Due to disease progression, the patient underwent medical therapy. PSA and testosterone were always at minimum levels. 20 months later the patient died. CONCLUSION We underline the uncertainty of the biological behaviour and optimal management of incidentally identified prostate carcinoma. In addition, we highlight that biological and clinical progression could be the consequence of inadequate treatment recommendations.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, University of Florence, Italy.
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75
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Bauduceau O, Vedrine L, Chargari C, Ceccaldi B, Le Moulec S, Houlgatte A. Métastase testiculaire d’un adénocarcinome prostatique : à propos d’un cas. Prog Urol 2007; 17:251-2. [PMID: 17489329 DOI: 10.1016/s1166-7087(07)92274-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Metastasis of prostate adenocarcinoma to testis is an extremely rare occurrence. Orchiectomy is necessary to confirm histopathological diagnosis. Metastatic carcinoma of the prostate to the testis is a commonly accepted as a sign of disseminated disease. Systemic treatment are therefore required. We report a case of a 62-year-old patient who presented a prostatic carcinoma with a testicular metastasis.
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Affiliation(s)
- Olivier Bauduceau
- Service d'Oncologie, Radiothérapie, HIA du VAL de Grâce, Paris, France.
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76
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Leibovici D, Spiess PE, Agarwal PK, Tu SM, Pettaway CA, Hitzhusen K, Millikan RE, Pisters LL. Prostate cancer progression in the presence of undetectable or low serum prostate-specific antigen level. Cancer 2007; 109:198-204. [PMID: 17171704 DOI: 10.1002/cncr.22372] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The serum prostate-specific antigen (PSA) level after definitive treatment for prostate cancer (PC) is a powerful predictor of outcome. Occasionally, PC progression can occur despite low or undetectable PSA levels. The authors report on the clinical and pathologic characteristics of patients who experienced PC progression with undetectable or low PSA levels. METHODS From an electronic database of all patients with PC who were treated at The University of Texas M. D. Anderson Cancer Center between 1999 and 2004, a group of 46 patients was identified who had progression to metastatic PC detected with concomitant PSA levels from 0.1 ng/mL to 2 ng/mL. Patient charts were reviewed for tumor stage, Gleason score, pretreatment PSA level, and the presence of atypical histologic variants (ie, ductal, sarcomatoid, or small cell cancers). The nadir PSA level after treatment and the PSA level at the time metastatic PC was detected were determined. The patients were followed semiannually, and imaging studies were obtained at the discretion of treating physicians. The sites of metastasis and histologic confirmation were reported when available. RESULTS Twenty-three of 46 patients underwent radical prostatectomy, 11 patients received radiation therapy, and 12 received hormone treatment as their initial form of therapy. Progression to metastatic disease with concomitant, undetectable PSA levels occurred in 10 patients, including 3 patients who had not received treatment with hormones. The sites of metastasis included bone (n = 35 patients), liver (n = 7 patients), retroperitoneal lymph nodes (n = 5 patients), lungs (n = 4 patients), and brain (n = 1 patient). Aggressive and locally advanced PC were common features in these patients: Eighty-five percent had Gleason scores >or=7, 63% had clinical T3 or T4 tumors, and 41% had pretreatment PSA levels >10 ng/mL. Atypical histologic variants were observed in 21 patients (46%) and in 8 of 10 patients who progressed with undetectable PSA levels. In 10 patients (22%), metastasis were detected in the presence of an undetectable PSA level. Eight of those patients had small cell carcinoma. In 19 patients (41%), progression to metastasis occurred without any increase in their PSA from the nadir level. Thirty-one patients (67%) were asymptomatic at the time metastasis was detected, and the detection of metastasis in these patients occurred only because of routine imaging studies. CONCLUSIONS Progression of PC may occur despite undetectable or low PSA levels. Complete physical evaluation and imaging studies may be indicated in the surveillance of patients with high-grade, locally advanced tumors, especially when atypical histologic variants are present.
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Affiliation(s)
- Dan Leibovici
- Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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77
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Abstract
Most neoplastic scrotal masses ultimately prove to be germ cell tumours and are recognisable with routine haematoxylin and eosin-stained sections. The differential diagnosis may be focused, even before reviewing histological sections, by knowledge of patient age, medical history, tumour site (testicular vs paratesticular) and gross findings. Some cases may prove to be diagnostically challenging, including rare tumours, a common tumour with an unusual pattern, a metastatic tumour, or a neoplasm with features that mimic another tumour. Several morphological patterns are seen with some frequency and these generate recurring sets of differential diagnostic considerations. These common patterns include testicular tumours with a predominant diffuse arrangement of cells with pale to clear cytoplasm, tumours with a glandular/tubular pattern, tumours with a microcystic pattern and tumours composed of oxyphilic cells. Intratubular proliferations of atypical cells, paratesticular glandular and/or papillary tumours, or tumours with spindle cell morphology can also be challenging to diagnose correctly. In some problematic cases, immunohistochemical staining may be useful to resolve these differential diagnoses.
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Affiliation(s)
- Robert E Emerson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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78
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Deb P, Chander Y, Rai RS. Testicular metastasis from carcinoma of prostate: report of two cases. Prostate Cancer Prostatic Dis 2007; 10:202-4. [PMID: 17224911 DOI: 10.1038/sj.pcan.4500942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the high incidence of prostatic adenocarcinoma and its ability for wide dissemination, metastatic involvement of testis is rather uncommon. We report two cases (aged 76 and 55 years, respectively), where unilateral testicular metastasis was incidentally discovered after bilateral orchiectomy following detection of adenocarcinoma prostate in six-quadrant trucut specimen. Both patients had obstructive voiding symptoms, hard nodular prostate on direct rectal examination and raised serum prostate-specific antigen levels, without associated systemic or testicular symptoms. Extensive evaluation excluded any other possible primary, although axial skeletal metastasis was detected on radionucleotide bone scans, in the first case. These cases highlight the need for proper evaluation of testes and para-testicular structures, for accurate staging of these tumors and to exclude any possible metastasis.
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Affiliation(s)
- P Deb
- Department of Pathology, Command Hospital (Northern Command), Udhampur, Jammu and Kashmir, India.
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79
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Gong Y, Caraway N, Stewart J, Staerkel G. Metastatic Ductal Adenocarcinoma of the Prostate. Am J Clin Pathol 2006. [DOI: 10.1309/4tt6lvjpqvfwdb6p] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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80
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Emerson RE, Ulbright TM. The use of immunohistochemistry in the differential diagnosis of tumors of the testis and paratestis. Semin Diagn Pathol 2006; 22:33-50. [PMID: 16512598 DOI: 10.1053/j.semdp.2005.11.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although most testicular and paratesticular tumors can be recognized by their light microscopic features, some raise significant differential diagnostic questions. Immunohistochemical staining has proved of significant value in this situation. There is still a role for the traditional markers, including placental-like alkaline phosphatase and alpha-fetoprotein, but newer markers provide additional support and often have greater sensitivity and specificity for many diagnoses. OCT4 is virtually 100% sensitive and specific for seminoma, embryonal carcinoma, and intratubular germ cell neoplasia, unclassified type. Inhibin-alpha, among testicular tumors, is limited to those in the sex cord-stromal category or those having adrenocortical-type differentiation (testicular tumor of the adrenogenital syndrome) or of trophoblastic lineage. Calretinin is another positive marker for the sex cord-stromal tumors but has less specificity. Additional markers, including differential cytokeratins, c-kit, CD30, epithelial membrane antigen, S-100, melan-A, and others, are useful in specific situations. This article reviews the application of immunohistochemical markers for a number of differential diagnostic considerations in the testis and paratestis categorized according to their light microscopic patterns.
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Affiliation(s)
- Robert E Emerson
- Department of Pathology, Indiana University School of Medicine, Indianapolis, USA
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81
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Menchini-Fabris F, Giannarini G, Pomara G, De Maria M, Manassero F, Mogorovich A, Selli C. Testicular metastasis as isolated recurrence after radical prostatectomy. A first case. Int J Impot Res 2006; 19:108-9. [PMID: 16554855 DOI: 10.1038/sj.ijir.3901460] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prostate cancer synchronously or metachronously metastasizing to the testis is a rare finding. We herein report on the first case of a solitary testicular metastasis from an organ-confined prostate cancer, diagnosed 6 months after a radical prostatectomy, without evidence of previous or concomitant biochemical and local recurrence.
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82
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Xie LP, Qin J, Zheng XY, Chen ZD. Undescended epididymo-testicular metastasis from prostatic carcinoma. Asian J Androl 2006; 8:251-2. [PMID: 16491280 DOI: 10.1111/j.1745-7262.2006.00118.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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83
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Schneider A, Kollias A, Woziwodzki J, Stauch G. Hodenmetastase eines metachronen kleinzelligen neuroendokrinen Prostatakarzinoms nach Hormontherapie eines Adenokarzinoms der Prostata. Urologe A 2006; 45:75-80. [PMID: 16307224 DOI: 10.1007/s00120-005-0945-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Secondary malignant testicular tumors are rare, with the exception of infiltrations by lymphomas and leukemias. Metastases are sometimes found in cancers of the lung, gastrointestinal tract, kidney, skin and prostate. Less than about 200 cases of testicular metastasis of prostate cancer have been described in the literature. This is this a very small number in comparison to the high incidence of prostate cancer and the vast number of orchiectomies for operative hormone deprivation in advanced cases. The testicle metastases described are mostly unilateral and are often found as ductal carcinoma of the prostate. In our case, the testicular metastasis from a small cell prostate carcinoma appeared 2.5 years after androgen deprivation of an adenocarcinoma of the prostate.
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Affiliation(s)
- A Schneider
- Klinik für Urologie und Kinderurologie, Ammerland Klinik GmbH, Lange Strasse 38, 26655 Westerstede.
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84
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Abstract
Prostate cancer is a disease that appears with a very high frequency. However, the presence of metastasis to the penis is rare. Only 98 cases reported in the literature up to 2003. We present one case of a patient with painless metastatic nodules on the penis secondary to a prostate cancer.
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Affiliation(s)
- J R Cortés González
- Servicio de Urología, Servicio de Anatomía Patológica, Hospital Universitario Jose E Gonzdlez UANL, Monterrey, NL, México.
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85
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Fiorello M, Fulcoli V, Lavelli D, Bortuzzo G. Prostate Cancer with Testicular Metastasis: A Case Report and Mini-Review of the Literature. Urologia 2004. [DOI: 10.1177/039156030407100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 64-year-old man, who had undergone a radical retropubic prostatectomy with pelvic lymphadenectomy for presumed local confined prostate cancer, was find to have a pT3bN0M0 Gleason 5 tumor. Seven year after the operation, patient complained a painless right testicular mass. Pathologic examination, after radical orchidectomy, revealed a testicular metastasis of the primary tumor.
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Affiliation(s)
- M. Fiorello
- U.O.A. di Urologia, Ospedale di Camposampiero (Padova)
| | - V. Fulcoli
- U.O.A. di Urologia, Ospedale di Camposampiero (Padova)
| | - D. Lavelli
- U.O.A. di Urologia, Ospedale di Camposampiero (Padova)
| | - G. Bortuzzo
- Anatomia Patologica, Ospedale di Camposampiero (Padova)
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86
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Philip J, Mathew J. Penile metastasis of prostatic adenocarcinoma: Report of two cases and review of literature. World J Surg Oncol 2003; 1:16. [PMID: 14521716 PMCID: PMC212152 DOI: 10.1186/1477-7819-1-16] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2003] [Accepted: 09/14/2003] [Indexed: 02/25/2023] Open
Abstract
Background Carcinoma of the prostate metastasising to the penis is rare. These patients have a poor prognosis receiving various treatment modalities. Case presentation Two such patients are discussed here having received differing therapeutic regimes, pointing out the necessity for standardised palliative treatment rather than radical therapy. Conclusion Management of patients with penile metastases from carcinoma of the prostate should emphasise improving quality of life with palliative treatment rather than radical therapy
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Affiliation(s)
- Joe Philip
- Department of Urology, Royal Cornwall Hospital (Treliske), Truro, Cornwall, TR1 3LJ, United Kingdom
| | - Joseph Mathew
- Department of Histopathology, Royal Cornwall Hospital (Treliske), Truro, Cornwall, TR1 3LJ, United Kingdom
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