Large Prostatic Mass in a Geriatric Patient

Interesting Cases in PR

|

June 30, 2023

Large Prostatic Mass in a Geriatric Patient

In this case, a 64-year-old male patient was referred to the urologist due to 7.41 ng/mL PSA levels. The patient's previous medical history includes hyperlipidemia and hypertension. During the physical evaluation, the patient reported acute lumbar pain and discomfort after getting out of bed; rectal examination suggests a hard prostate with a III/IV size. As a result, an MRI was ordered and yielded a prostate volume of 85 mL. Subsequently, a biopsy was performed and the microscopic evidence looks as follows.

‍

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

‍

What is the most likely diagnosis?

a. Poorly Differentiated Metastatic Colon Adenocarcinoma

b. Prostate Adenocarcinoma Grade Group 5

c. Small Cell Carcinoma of the Prostate

d. Leiomyosarcoma

‍

Read full article

Click here to open the document

Click here to see the answer

After a prostatic ultrasound-guided biopsy was performed, pathological analysis of the tissue sampled showed invasion of the stroma by high-grade carcinoma composed of clusters of small cells with scant cytoplasm and granular salt-and-pepper chromatin nuclei. The nucleoli were poorly visible, and abundant cell mitoses were identified. Cytokeratins AE1/AE3, CAM 5.2, TTF-1, CD56, p63 and neuroendocrine markers such as synaptophysin, and chromogranin A were among the positive immunostains that were performed. Similarly, CK20, PSA, PSAP, NKX3.1 and p53 were tested but yielded a negative result; all consistent with small cell carcinoma of the prostate.

Current literature suggests that between 0.5% - 2% of all prostate cancers are small cell carcinomas. These neoplasms are particular due to the fact that they produce hormones of ectopic origin and are commonly associated with paraneoplastic syndromes.

References

Abdul Rauf, Stephanie F Smith, Rono Mukherjee, Nyla Nasir, Not such a small diagnosis: small cell carcinoma of the prostate, Journal of Surgical Case Reports, Volume 2020, Issue 6, June 2020.

Bell, P.D., Huber, A.R. & Agostini-Vulaj,D. Clinicopathologic features of metastatic small cell carcinoma of the prostate to the liver: a series of four cases. DiagnPathol 16, 35 (2021). https://doi.org/10.1186/s13000-021-01096-1.

Bhandari, Rahul et al. “Small Cell Carcinoma of the Prostate: A Case Report and Review of the Literature.” Cureus vol. 12,2 e7074. 22 Feb. 2020,doi:10.7759/cureus.7074.

Nadal, Rosa et al. “Small cell carcinoma of the prostate.” Nature reviews. Urology vol.11,4 (2014): 213-9. doi:10.1038/nrurol.2014.21.

‍

Collaborators

José Lev Alvarez Gómez, BS, MA, MA (Content), Juan C. Santa Rosario, MD (Images and Edition) and Dario Sanabria Bellassai, MD (Edition).

‍