Left axillary lymphadenopathy as initial presentation of metastatic prostate cancer: A rare case report

Abstract

Highlights Theoretically, prostate cancer can spread to any part of the body. Metastasis to axillary lymph node in a patient with normal urologic examination is rare. It may delay the diagnosis. A high suspicion index is essential in males presenting with symptoms suggestive of chest and abdominal-pelvic cancer.

Case report: PSMA PET/CT addresses the correct diagnosis in a patient with metastatic prostate cancer despite negative core biopsies and mpMRI. A diagnostic challenge

“…Our case reflects this concept, not common but well known among clinicians, displaying a heterogeneous scenario in a single patient with absent PSMA expression in the primary tumour but with high PSMA expression in multiple nodes and bone Pca metastasis. Moreover, although other episodes of uncommon locations for Pca presentation are reported in literature, like Virchow’s node or gingival metastasis ( 10 – 12 ), the peculiarity of this case is represented by the metastatic presentation in whom, interestingly, none of the diagnostic techniques were able to detect the primary tumour within the prostate gland. It is well recognized that several malignancies can present with subdiaphragmatic nodal findings and PSMA is not a purely prostate-specific radiotracer, therefore the presence of multiple PSMA avid lymphadenopathies could have also raised the suspicion of lymphoma; however, the osteoblastic bone lesion was more suggestive of Pca.…”

Cervical lymphadenopathy as initial presentation of metastatic prostate cancer: A retrospective study of five cases and literature review

“…The axial skeleton and regional lymph nodes are the most common sites of metastases for prostate cancer,followed by the lungs, bladder, liver and adrenal glands ( 3 ). However, distal metastases to the cervical lymph nodes are very rare, especially as an initial presentation for prostate cancer ( 4 ), the incidence of this condition is less than 0.15% ( 5 ). Besises, the presence of metastatic lymph nodes is a poor prognostic factor in patients with prostate cancer, and the survival rates are significantly reduced in such patients ( 6 ).…”