Chest-Wall Metastasis of Prostate Cancer

Abstract

A n 88-year-old male presented with a gradually enlarging, painless mass on his anterior chest wall for 1 year (Panel A). On exam, there was a 12×10×5 cm, nontender, firm, immobile mass over the body of the sternum. Computed tomography (CT) demonstrated a permeative chest-wall mass (Panel B). Serum prostate-specific antigen (PSA) was 3,019 ng/ml. Histopathology was consistent with prostate adenocarcinoma. The patient had poor functional status and requested hospice.Chest wall tumors account for less than 1 % of all neoplasms and can arise from either a soft tissue or bony structure.1 More than 50 % of chest wall tumors are malignant. Malignant primaries include Ewing's sarcoma, osteosarcoma and chondrosarcoma. Malignant lesions tend to grow faster, are painful, and present as larger masses than benign lesions. Primary malignant tumors of the chest wall should be resected with wide margins and receive adjuvant therapy as appropriate. Metastatic disease accounts for 16 % of malignant chest wall tumors. Chest wall metastases occur more commonly from blood-borne spread than lymphatic or direct spread. The chest wall is an extremely rare site of prostate cancer metastasis. 3 Case reports have described chest-wall metastasis regression with standard hormonal chemotherapy, with median survival of 12-24 months. dashed arrow).1888

Metastatic prostate adenocarcinoma presenting as a large right supraclavicular and anterior chest wall mass

“…The patient had no symptom of any lower urinary tract symptoms and a possible prostate primary was not generated as a differential and serum PSA level was not investigated until a later time point 13 14. Interestingly, Matei and Bhushan15 have presented, in 2015, a singular case of metastatic prostate cancer presenting as a central chest wall mass eroding the sternum and abutting the pericardium as well as mediastinal fat.…”