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Table of Contents
CASE REPORT
Year : 2012  |  Volume : 11  |  Issue : 4  |  Page : 230-233  

Renal metastasis from prostate adenocarcinoma: A potential diagnostic pitfall


1 Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
2 Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
3 Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
4 Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Date of Web Publication24-Oct-2012

Correspondence Address:
Philip O Ibinaiye
Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.102854

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   Abstract 

Renal metastasis from prostatic origin is an uncommon event. Advanced prostate cancer locally invades the seminal vesicles, bladder and regional lymph nodes. Other metastatic sites are the lung, bone and other visceral organs. We present a 55-year old, Hausa man from Northern Nigeria who was managed as a case of infected renal cyst which later turned out to be a metastatic prostatic adenocarcinoma with a rare pattern of widespread bony metastases.Renal metastasis from prostate adenocarcinoma is a rare occurrence, however, high level of suspicion is needed in order to avoid potential diagnostic pitfall.

   Abstract in French 

Métastases rénales d'origine bénigne de la prostate est un événement rare. Cancer avancé de la prostate localement envahit les vésicules séminales, la vessie et les ganglions lymphatiques régionaux. Autres sites métastatiques sont les poumons, les os et les autres organes viscéraux. Nous présentons un 55 ans, homme haoussa du Nord du Nigeria qui a été géré comme un cas d'infectés kyste rénal qui plus tard s'est avéré pour être un adénocarcinome prostatique métastatique avec un motif rare des métastases osseuses généralisées. Métastases rénales d'adénocarcinome de la prostate est rare, cependant, un niveau élevé de suspicion est nécessaire afin d'éviter l'écueil de diagnostic possible.
Mots clés: Piège diagnostic, cancer de la prostate, métastases rénales

Keywords: Diagnostic pitfall, prostate carcinoma, renal metastasis


How to cite this article:
Ibinaiye PO, Mbibu H, Shehu SM, David SO, Samaila MO. Renal metastasis from prostate adenocarcinoma: A potential diagnostic pitfall. Ann Afr Med 2012;11:230-3

How to cite this URL:
Ibinaiye PO, Mbibu H, Shehu SM, David SO, Samaila MO. Renal metastasis from prostate adenocarcinoma: A potential diagnostic pitfall. Ann Afr Med [serial online] 2012 [cited 2020 Aug 13];11:230-3. Available from: http://www.annalsafrmed.org/text.asp?2012/11/4/230/102854


   Introduction Top


Primary neoplasms that commonly metastasize to the kidney as solitary large masses originate from the lung, breast, esophagus, colon and melanoma. [1] Advanced prostate cancer usually invade contiguous structures such as the seminal vesicles, bladder and regional lymph nodes. Distant metastasis may be seen in the bones and other visceral organs while metastasis to the kidney is a rare event. [1],[2]


   Case Report Top


A 55-year old Hausa man from Northern Nigeria presented to our hospital with a left flank pain of a month's duration, fever, nausea and a week history of loss of appetite. Physical examination revealed an ill looking man with a temperature of 40°C and a left flank tenderness. His blood parameters, electrolytes and urea levels were essentially normal. Rectal examination was however not done. Renal ultrasound scan showed a well circumscribed rounded left renal cystic 3×4.5 cm mass in the upper pole with multiple low level echoes within it. It was diagnosed as an infected renal cyst. The patient was placed on antibiotics and analgesics.

He represented six months later with severe left flank pain, hematuria, vomiting and a month history of right upper chest and back pain. He was anemic with hemoglobin of 7g/dl. His chest radiograph showed a solitary osteoblastic deposit on the right first anterior rib [Figure 1] while skeletal survey showed osteoblastic deposits on the right pedicle of L1, body of L4 and the pubic bones [Figure 2]. A repeat ultrasound also revealed a lobulated 10.5 × 6.8 cm cystic mass with solid internal component in the upper pole of the left renal parenchyma [Figure 3] which was diagnosed as a renal tumor.
Figure 1: Plain radiograph of the chest (anterior-posterior view) showing focal osteoblastic deposit to the right first anterior rib

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Figure 2: Plain radiograph of the lumbosacral spine (anterior-posterior view) showing osteoblastic deposits to pedicles of first lumbar vertebra and body and pedicles of fourth lumbar vertebra

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Figure 3: Renal ultrasound scan (longitudinal scan) showing mixed echogenic mass in the upper pole of the left kidney

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The osteoblastic deposits from the skeletal survey triggered a search for a likely primary site rather than the kidney which is an uncommon organ for this pattern of metastatic deposits. Thus, a transrectal ultrasound scan (TRUS) was done and it revealed nodular prostatic enlargement while a Tru-cut biopsy [Figure 4] showed a poorly differentiated prostatic adenocarcinoma (Gleason score-7). He also had a fine needle aspiration biopsy of the renal mass which showed malignant cells with the cytological appearance of prostate adenocarcinoma and this was handled by two experts and experienced histopathologists. PSA staining was not done on the smears due to non-availability of the reagents in our center. However, the serum prostate specific antigen (PSA) assay was elevated (150 ng/ml).
Figure 4: Histology of the prostate specimen showing well formed tubules/acinar lined by single layer malignant cuboidal epithelial cells

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He was scheduled for bilateral subcapsular orchidectomy to be followed by 50mg daily of bicalutamide (an anti-androgen). However, the patient refused surgery and absconded against medical advice.


   Discussion Top


Carcinoma of the prostate is the second most common malignancy in men and may metastasize to any part of the body. Increasing age confers greater risk for the development of this disease. [3],[4] The peak age incidence is 55 years in Black African men and our patient falls within this age group. [4] Prostate cancer commonly metastasize to the bones and lymph nodes while several metastatic sites are rarely discovered ante-mortem. [5] To the best of our knowledge from literature searches, this is the second case of renal metastasis from prostatic adenocarcinoma diagnosed ante-mortem by percutaneous fine needle aspiration. Though, unusual sites of prostatic metastases are widely documented in literature from postmortem findings, Gunlusoy et al[1] and Denti et al[6] respectively reported postmortem findings of bilateral and unilateral renal metastases from prostate carcinoma which was initially misdiagnosed as renal cell carcinoma.

The cytologic and morphologic appearance of primary renal cell carcinoma is quite distinct from prostatic adenocarcinoma and thus, diagnosis can be made on morphology alone as in the index case. The metastatic spread to the kidney from other primary sites have peculiar growth pattern and are usually positive for S-100 protein as seen in index case. The efficacy and accuracy of the fine needle aspiration biopsy technique in the evaluation of palpable masses cannot be over-emphasized. It was the pointer to the prostate in this case. Kutcher et al[2] also confirmed the efficacy and safety of this procedure in the ante-mortem diagnosis of renal metastasis of prostatic origin.

Gholam et al[5] reported an unusual rare combination of metastases from the prostate to both kidneys, both adrenals, both breasts, the head of pancreas and one testis at autopsy without bony involvement. Our case had an unusual focal widespread metastases on the rib, lumbar vertebrae and pelvic bones. To our knowledge, no similar pattern has been reported in literature. Other reported rare sites of metastasis are the brain, larynx, oral cavity and paranasal sinuses. [7],[10]

An understanding of the tumor biology such as tumor aggressiveness and extra-prostatic extension will create better insight to the metastatic pattern of this disease. Early detection also confers better prognostic outcome and a combination of direct rectal examination (DRE), transurethral ultrasonography and serum PSA are invaluable in diagnosis. [11],[12]

Invasive lesions into the rectum have been reported [13],[15] and may mimic primary rectal Carcinoma and thus, a rectal examination is mandatory. DRE could have detected the prostatic mass earlier in this patient. Extra rectal deposits may also present with constipation as documented by Kant et al. [16] Studies have demonstrated that FDG-PET (positron emission tomographic with 18- fluorodeoxyglucose) scanning may play an important role in the evaluation of advanced androgen-independent disease and in the staging and evaluation of response to hormonal manipulations in high-risk localized and locally advanced prostate cancers. [17] This may be helpful in detecting rare metastatic sites ante-mortem.

Metastatic prostate cancer carries a poor prognosis while the effect of the unusual metastatic sites on the management and prognosis is largely unknown. However, management strategy remains the same. Surgical or medical castration is the standard of therapy while hormonal manipulation may not yield any appreciable response. The degree of differentiation may also be a good prognostic indicator in this regard.


   Conclusion Top


Renal metastasis from prostate adenocarcinoma is a rare occurrence, however, high level of suspicion is needed in order to avoid potential diagnostic pitfall.


   Acknowledgements Top


The authors appreciate the contribution of the resident doctors and nursing staff of the Radiology, Urology, Medicine and Pathology departments in the management of this patient.

 
   References Top

1.Gunlusoy B, Arslan M, Selek E, Sayhan HS, Minareci S, Cicek S. A case report: Renal metastasis of prostate cancer. Int Urol Nephrol 2004;36:555-7.   Back to cited text no. 1
    
2.Kutcher R, Greenebaum E, Rosenblatt R and Moussouris HF. Prostatic carcinoma metastasis to the kidney: Diagnosis by thin needle aspiration biopsy. Urol Radiol 1986;8:98-100.  Back to cited text no. 2
    
3.Ibinaiye PO, Adeyinka AO, Obajimi MO. Comparative evaluation of protatic volume by transabdomiral and transrectal ultrasonography in patients with prostatic hypertrophy in Ibadan. Eur J Sci Res 2005;10:6-14.  Back to cited text no. 3
    
4.Available from: http://www.cancercenter.com/home/90/prostate/prostate2.cfm. [Last accessed on 2011 Jun 2].  Back to cited text no. 4
    
5.Malek GH, Madsen PO. Carcinoma of the prostate with unusual metastases. Cancer 1969;24:194-7.  Back to cited text no. 5
[PUBMED]    
6.Denti F, Wisard M, Guillou L, Francke ML, Leisinger HJ. Renal metastasis from prostatic adenocarcinoma: A potential diagnosis pitfall. Urol Int 1999;62:171-3.  Back to cited text no. 6
[PUBMED]    
7.Puduvalli VK, Tremont-Lukats IW, Bobustuc G, Lagos GK, Lolas K, Kyritsis AP. Brain metastasis from prostate carcinoma. Cancer J Clin 2003;98:363-8.  Back to cited text no. 7
    
8.Coakley JF, Ranson DL. Melaslasis to the larynx from a prosatic carcinoma: A case report. J Laryngol Otol 1984;98:839-42.  Back to cited text no. 8
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9.Damodaran D, Kathiresan N, Satheesan B. Oral cavity metastasis: An unusual presentation of carcinoma of prostate. Indian J Urol 2008;24:112-3.  Back to cited text no. 9
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10.Viswanatha B. Prostatic carcinoma metastatic to the paranasal sinuses: A case report. Ear, Nose & Throat J 2008;87:519-20.  Back to cited text no. 10
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11.Yu KK, Scheidler J, Hricak H, Vigneron DB, Zaloudek CJ, Males RG. Prostate cancer: Prediction of extracapsular extension with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging. Radiology 1999;213:481-8.  Back to cited text no. 11
    
12.Babaian RJ, Mettlin C, Kane R, Murphy GP, Lee F, Drago JR. The relationship of prostate-specific antigen to digital rectal examination and transrectal ultrasonography. Findings of the American cancer society National Prostate Cancer Detection Project. Cancer 1992;69:1195-200.   Back to cited text no. 12
    
13.Barringer BS. Carcinoma of prostate. Surg Gynaecol-Obstet 1922;34:168-76.  Back to cited text no. 13
    
14.Graves RC, Militzer RE. Carcinoma prostate with metastasis. J Urol 1935;33:235-51.  Back to cited text no. 14
    
15.Lazarus JA. Complete rectal occlusion necessitating colostomy due to carcinoma prostate. Ann Afr Med 1935;30:502-5.  Back to cited text no. 15
    
16.Kant K, Dasgupta HK. Unusual metastasis of carcinoma of the prostate (a case report). J Postgrad Med 1983;29:186-7.  Back to cited text no. 16
[PUBMED]  Medknow Journal  
17.Sanz G, Robles JE, Gimenez M, Arocena J, Sanchez D, Rodriguez-Rubio F, et al. Positron emission tomography with 18 fluorine-labeled deoxyglucose: utility in localized and advanced prostate cancer. BJU Int 1999;84:1028-31.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


This article has been cited by
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Chao Chen,Huadong He,Zhijian Yu,Yuansong Qiu,Xuliang Wang
World Journal of Surgical Oncology. 2016; 14(1)
[Pubmed] | [DOI]



 

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