Effectiveness of Virchow’s Node Fine-Needle Biopsy for the Discovery of Occult Metastatic Prostate Cancer

In this case report, we describe the effectiveness of fine-needle aspiration of Virchow’s node for the diagnosis of metastatic prostate cancer in a 62-year-old male without any medical history, negative urinary tract symptoms, and a normal digital rectal examination. The patient presented with respiratory distress, diffuse lymphadenopathy, and high levels of prostate-specific antigen. Multiple studies were done with inconclusive results until positive findings of the NKX3.1 gene were found in the immunostain smear of the Virchow’s node, which led to the identification of metastatic prostate cancer.

Successful treatment of concomitant metastatic prostate cancer and B-cell non-Hodgkin's lymphoma with R-EPOCH chemotherapy regimen and antiandrogen therapy

A 70-year-old man presented with left loin pain without urinary symptoms. Initial investigations with CT showed enlarged para-aortic, mediastinal lymph nodes, right-side renal mass and enlarged prostate. A prostatic-specific antigen (PSA) was alarmingly high at 4750 μg/L (normal <4.0 μg/L). Further investigations included positron emission tomography (PET); both prostate-specific membrane antigen and 18-fluorodeoxyglucose as well as bone scan and bone marrow examination confirmed dual malignancies with B-cell non-Hodgkin's lymphoma (B-NHL) and wide spread metastatic prostatic adenocarcinoma (PA) to the skull, spine, pelvis, liver and lungs. The patient was treated with six cycles of rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin(R-EPOCH) containing regimen for B-NHL and goserelin hormonal therapy for PA. Restaging with PET scans thereafter showed complete remission of NHL with disappearance of his metastatic PA and normalisation of PSA levels. R-EPOCH regimen and antiandrogen therapy resulted in a good outcome and remission of both malignancies.