Subcutaneous and testicular metastasis from prostatic adenocarcinoma with neuroendocrine differentiation

• Autor(a) principal: Dénes, F. T.
• Data de Publicação: 2001
• Outros Autores: Brito, A. H., Dos Santos, A. M.
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNESP
• Texto Completo: http://www.brazjurol.com.br/janeiro_2001/Denes_52_54.pdf; http://hdl.handle.net/11449/66440
• topic: Neoplasm metastasis; Neuroendocrine differentiation; Prostate; Prostatic neoplasms; Subcutaneous; Testis; antineoplastic agent; cell marker; chromogranin; cyproterone; prostate specific antigen; abdominal wall; adjuvant chemotherapy; adult; antigen detection; axilla; bladder wall; blood level; bone scintiscanning; cancer infiltration; case report; computer assisted tomography; hematuria; human; male; metastasis; neuroendocrine tumor; neurosecretory cell; orchiectomy; pain; prostate adenocarcinoma; prostate biopsy; prostate hypertrophy; shoulder; spine metastasis; subcutaneous nodule; symptomatology; testis; tumor differentiation; urethra

The pathological finding of testicular metastasis in cases of disseminated prostatic adenocarcinoma is rare, but was more frequently reported in the past, when bilateral castration was performed more often. The existence of skin and subcutaneous metastasis adds a worse prognosis, because generally it is sign of advanced disease with an average survival time of less than one year. The synchronous occurrence of such metastasis has not been described previously, neither their association to neuroendocrine differentiation. The presence of such differentiation of prostatic adenocarcinoma represents a very unfavorable prognostic factor, as suggested in recent literature. Herein, we discuss the case of a 53 year old man, who presented with macroscopic hematuria and frequency associated to several painless subcutaneous nodules in left axilla and shoulder, as well as in the lower abdominal wall. The right testis was painful, endured and on rectal examination, the prostate was diffusely enlarged. Serum PSA was elevated, reaching 1760 ng/ml and prostatic biopsy disclosed a Gleason 10 prostatic adenocarcinoma with neuroendocrine differentiation. The same pathological pattern was detected in the right testis and in all subcutaneous nodules, documented by positive staining of chromogranin, a marker of neuroendocrine cells. He was submitted to a prostate tunnelization and maximal androgen blockade plus adjuvant chemotherapy, nevertheless, he died 5 months latter.