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Prostate Cancer Metastasis to Stomach: A Case Report and Review of Literature.

ABSTRACT: Metastatic prostate cancer is a common diagnosis with a protracted but terminal course. Gastrointestinal (GI) tract involvement is extremely rare, and reportedly portends a poor prognosis. It can present years after the initial prostate cancer diagnosis. Only fifteen cases of prostate cancer metastasis to the stomach have been reported in the literature. We report a case of a 72-year-old man with metastatic castration-resistant prostate cancer and extensive bony involvement. He presented a decade after the diagnosis of prostate cancer with signs of heartburn; a gastric biopsy was initially believed to represent primary gastric carcinoma, but subsequently a diagnosis of prostate cancer metastatic to the stomach was confirmed. This case highlights the importance of the provision of a pertinent clinical history and clinical differential diagnosis at the time of submission of surgical pathology specimens, as well as highlighting the need to have a low index of suspicion to pursue additional pathologic markers whenever a presumed second adenocarcinoma is noted in the context of a patient having a history of current or prior advanced-stage adenocarcinoma of another site. The correct diagnosis can shield the patient from the morbidity of inappropriate surgical or medical management.

SUBMITTER: Moshref L

PROVIDER: S-EPMC10137262 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Prostate Cancer Metastasis to Stomach: A Case Report and Review of Literature.

Moshref Leena L Abidullah Mohammad M Czaykowski Piotr P Chowdhury Amitava A Wightman Robert R Hebbard Pamela P

Current oncology (Toronto, Ont.) 20230330 4

Metastatic prostate cancer is a common diagnosis with a protracted but terminal course. Gastrointestinal (GI) tract involvement is extremely rare, and reportedly portends a poor prognosis. It can present years after the initial prostate cancer diagnosis. Only fifteen cases of prostate cancer metastasis to the stomach have been reported in the literature. We report a case of a 72-year-old man with metastatic castration-resistant prostate cancer and extensive bony involvement. He presented a decad ...[more]

PMID: 37185408

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Project description:IntroductionThe neuroendocrine differentiation in prostate cancer is a rare entity that may occur as de novo, or as a result of treatment with androgen deprivation. It is characterized by its rapid progression and poor prognosis, without elevation of the prostate specific antigen (PSA), which is why it is often diagnosed by biopsy of a site of metastasis; there are no established treatment regimens. In this case, metastasis was presented as implantation to a laparoscopic port. These implantations subsequent to laparoscopic procedures in prostate cancer are very rare, with an incidence between 0.09 and 0.7%. The exact pathogenesis of the tumor implantation at the insertion site is not clear, there are several theories.Materials and methodsWe describe the case of a 53-year-old patient with a diagnosis of prostate adenocarcinoma who underwent laparoscopic radical prostatectomy plus lymphadenectomy, staged as PT3BN0 (0/6) M0R1 Gleason 4 + 5. The patient never had negative PSA levels after the treatment, and presented elevation of the same, so radiotherapy was performed at a dose of 66 Gy plus antiandrogen deprivation therapy with leuprolide acetate for 30 months, with a decrease in PSA to 0.011 ng/ml, which remained stable. After 3 months of hormonal therapy, he presented with an umbilical mass on the scar of the laparoscopic port; ultrasound and computed tomography were performed, showing a solid mass dependent of the umbilical upper edge with a defect in the abdominal wall of 3 cm, as well as hepatic nodules suggestive of metastatic lesions and peritoneal implantations.ResultsA biopsy of the abdominal wall lesion was performed, documenting poorly differentiated carcinoma with an immune-profile consistent with neuroendocrine carcinoma; immunohistochemistry showed strong and diffuse positivity with cytokeratin cocktail and chromogranin. In conjunction with oncology, treatment with chemotherapy was decided. He received six cycles of cisplatin and etoposide, with progression of his disease and death seven months after diagnosis.ConclusionsProstate cancer with neuroendocrine differentiation is a rare entity, usually occurring in the castration resistance stage, with poor prognosis and survival of less than 1 year. It presents as clinical and radiological progression without elevation of the PSA. Although it is very rare, the possible causes include tumor implantation in laparoscopic ports and/or open surgery scars, so caution and certain precautions must be taken when performing radical prostatectomy. In case of suspecting a tumor with neuroendocrine differentiation, biopsy and immunohistochemistry studies should be performed in order to clarify the diagnosis and provide a multimodal treatment based on surgery, radiotherapy and chemotherapy.

Project description:BackgroundBreast cancer is the most common cancer in women. The tumor is prone to metastasize in the brain, lung, liver, bone, and other organs; however, generally, it is less likely to metastasize in the digestive tract. Thus, breast cancer metastasizes to colon is rarely happened and easily ignored by clinicians. Such misdiagnosis may lead to delay the further diagnosis and treatment of patients, or even cause the life danger of patients due to the progress of the disease. Therefore, we propose such case reports to arouse clinicians' attention to the rare case of digestive tract metastasis after treatment of breast cancer. We also conducted a retrospective analysis of the relevant case reports. We suggest that because breast cancer with gastrointestinal metastasis rarely occurs, and because of the lack of specificity of syndromes, it is easily misdiagnosed. Thus, the attention of the receiving doctor needs to be drawn to this tumor. We also summarized the specificity and sensitivity of the commonly used immunohistochemical detection indicators of digestive tract metastasis of breast cancer.Case descriptionWe presented a 67-year-old female went to hospital because of "acute pain in the right lower abdomen", after computed tomography (CT) examination, the patient was diagnosed as "acute appendicitis" and underwent laparoscopic appendectomy (LA), the post-surgery pathology confirmed metastatic carcinoma to the appendix from the breast that was removed 10 years early. The patient first came to our hospital 10 years ago because of the right breast malignant tumor. After modified radical mastectomy for right breast cancer, the patient underwent chemotherapy for 6 cycles. Tamoxifen endocrine therapy was administered after chemotherapy. The patient had a regular follow-up, with no signs of distant metastasis and local recurrence.ConclusionsMetastasis from breast cancer to the gastrointestinal tract is extremely rare. For patients with breast cancer, endoscopy should be adopted as a routine follow-up item. For suspicious lesions found under endoscopy, immunohistochemistry stain should be adopted to ensure the diagnosis. For lesions that are confirmed to be metastatic from breast cancer, proper treatment should be carried out based on patients' condition to improve the prognosis.

Project description:Background: One of the most serious complications of cranial radiotherapy is the development of radiation-induced glioma, which is estimated to occur in 1 to 4% of patients who have received cranial irradiation and has a worse prognosis than sporadic glioblastoma. To date, owing to its rarity, no standard of care has been established for radiation-induced glioma. Although comprehensive genetic analysis has recently uncovered the molecular characteristics of radiation-induced glioma, the full picture remains unclear, and the molecular features associated with treatment response and prognosis are poorly understood. Case presentation: A 45-year-old man presented with generalized seizures caused by multiple brain tumors involving the right frontal lobe, thalamus, and brainstem. The patient had a history of whole-brain radiotherapy for the recurrence of Burkitt's lymphoma at the age of 12. He underwent craniotomy, and the histological diagnosis was a high-grade glioma with isocitrate dehydrogenase-wildtype, which was presumed to be a radiation-induced glioma that developed 33 years after whole-brain irradiation. The Heidelberg DNA-methylation brain classifier most closely matched diffuse pediatric-type high-grade glioma, receptor tyrosine kinase-1 subtype, which is a typical methylation class of radiation-induced glioma. Methylation-specific polymerase chain reaction showed that the O6-methylguanine-DNA methyltransferase gene promoter was unmethylated. Next-generation sequencing identified CDKN2A/B deletion as well as co-amplification of several receptor tyrosine kinase-encoding genes including PDGFRA, KIT, and KDR, which are all located on chromosome 4q12. Amplification of this region is present broadly across cancers and is associated with a poor prognosis in sporadic glioblastoma. Nevertheless, the patient received conventional chemoradiotherapy with temozolomide. Subsequent multimodal imaging with magnetic resonance imaging and 11C-methionine positron emission tomography revealed complete remission of all lesions. Two years later, the patient is currently alive with a favorable performance status. Conclusions: Despite radiation-induced glioma with molecular features suggestive of an aggressive phenotype, our patient unexpectedly responded well to conventional chemoradiotherapy, resulting in complete remission that is exceptional in sporadic glioblastoma. Our case indicates that some of the radiation-induced gliomas may have distinct molecular characteristics involved in the therapeutic response that differ from those of sporadic glioblastomas.

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Prostate Cancer Metastasis to Stomach: A Case Report and Review of Literature.

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Prostate Cancer Metastasis to Stomach: A Case Report and Review of Literature.

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