|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 217-218
Mesenteric adenopathy and malignant ascites in prostatic adenocarcinoma: An unusual presentation
MR Pradhan1, K Pradhan2, R Kapoor1
1 Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
2 Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
|Date of Web Publication||5-Feb-2016|
M R Pradhan
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pradhan M R, Pradhan K, Kapoor R. Mesenteric adenopathy and malignant ascites in prostatic adenocarcinoma: An unusual presentation. Indian J Cancer 2015;52:217-8
Prostate cancer primarily presenting with abdominal symptoms, ascites, and mesenteric adenopathy is quite rare.
A 70-year-old male patient presented with vague abdominal pain and constipation for two months. On enquiry, he had a history of occasional backache, moderate voiding lower urinary tract symptoms (IPSS-11, bother score-2), anorexia, and weight loss (7 kg) for the last four months. There was no history of fever, jaundice, hematuria, hematemesis, or melena. He was anemic, with no icterus or generalized lymphadenopathy. Abdominal examination revealed mild fullness of the flanks, with an ill-defined, firm-to-hard mass palpable in the left hypochondrium and lumbar area. The external genitalia were normal. Rectal examination revealed an enlarged prostate with firm-to-hard nodular areas. Laboratory investigations showed hemoglobin of 6.8 g/dl with normal renal parameters and liver enzymes, except serum alkaline phosphatase of 614 IU/L. Urine analysis was normal. Ultrasonography of the abdomen showed mild hepatomegaly, with no metastatic hepatic lesions and multiple enlarged retroperitoneal, mesenteric, and pelviclymph nodes. There were mild ascites, with multiple small nodular lesions seen over the inner abdominal wall, suggestive of peritoneal deposits. Bilateral kidneys had multiple small calyceal stones, with no hydronephrosis. Contrast-enhanced computed tomography (CECT) revealed multiple confluent and discrete lymph nodes in the mesenteric, retroperitoneal, and pelvic areas (more on the left side), with displacement of the urinary bladder to the right, by the nodal mass. The prostate was enlarged, with multiple calcifications. The patient initially presented to the Gastroenterology Outpatient Department (OPD), wherein the ultrasound-guided fine-needle aspiration cytology of the retroperitoneal nodal mass was suggestive of metastatic adenocarcinoma [Figure 1]a. Ascitic fluid analysis showed exudative characteristics, with cells of adenocarcinoma origin. The serum levels of the carcinoembryonic antigen (CEA) and CA 19-9 were normal. Gastroduodenoscopy and colonoscopy revealed no abnormality and the patient was referred to us for a further workup. On evaluation, the serum prostate-specific antigen (PSA) was found to be 52 ng/ml. Prostatic needle-core biopsy showed adenocarcinoma, with a Gleason score of 4 + 4 [Figure 1]b. The bone scan was suggestive of extensive skeletal metastases to the vertebrae, pelvic bones, and ribs. The patient was started on hormonal therapy, following which, the abdominal pain improved and the palpable abdominal mass disappeared within six weeks. Subsequently the patient opted for further treatment at his local place.
|Figure 1: (a) Cytology smear showing clusters of atypical cells with formation of acini in places, displaying round-to-oval hyperchromatic nuclei, and a moderate amount of cytoplasm, consistent with metastatic adenocarcinoma (Magnification: ×40). (b) Prostate tissue histopathology, showing adenocarcinoma, with Gleason grade 4 + 4 (Magnification: ×40)|
Click here to view
Prostate cancer most commonly metastasizes to the pelvic and retroperitoneal lymph nodes and bone. Mesenteric adenopathy and peritoneal involvement with ascites are mainly seen in gastrointestinal malignancies. Cancer of the prostate that presents predominantly with these features is very rare and usually signifies a widely disseminated disease, with poor prognosis. Only few cases have been reported., An autopsy study of 144 American black men with prostate cancer found mesenteric adenopathy and peritoneal carcinomatosis in one and three patients, respectively. A review of 1429 staging abdominal CT scans of prostate cancer patients found metastatic retroperitoneal adenopathy in only two cases.
Therefore, the prostate could rarely be the source of peritoneal carcinomatosis, mesenteric adenopathy, or ascites, and any elderly male presenting with these symptoms should also be evaluated to rule out prostate cancer.
| » References|| |
Lapoile E, Bellaïche G, Choudat L, Boucard M, El Belachany G, Ley G, et al
. Ascites associated withprostate cancermetastases: An unusual localisation. Gastroenterol Clin Biol 2004;28:92-4.
Houghton A, Marsh J, Sopher M, Stoker A, Vandal M. Don't forget prostatic carcinoma in abdominal carcinomatosis. J Gastroenterol Hepatol 1994;9:277.
Lamothe F, Kovi J, Heshmat MY, Green EJ. Dissemination of prostate cancer: An autopsy study. J Natl Med Assoc1986;78:1083-6.
Coakley FV, Lin RY, Schwartz LH, Panicek DM. Mesentericadenopathy in patients with prostatecancer: Frequencyandetiology. AJR Am J Roentgenol 2002;178:125-7.