Metastatic prostate adenocarcinoma to cervical lymph nodes: an unusual diagnosis on fine-needle aspiration biopsy

Albadri, Sam T.; Salomão, Diva R.

doi:10.1016/j.jasc.2020.08.009

Cited by 5 publications

(11 citation statements)

References 21 publications

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“…The diagnosis of MPC on FNA is often uncomplicated. Conventional PC shows characteristic cytomorphology (acinar formations, prominent nucleoli) and immunohistochemical staining (NXK3.1 and PSA expression) 8‐10 . Therapy‐naive MPC is generally of the conventional type; however, treatment history can have a significant impact on the features of MPC.…”

Section: Discussionmentioning

confidence: 99%

“…Erythroblast transformation-specific-related gene protein (ERG) rearrangements are common early in prostate cancer development and can be detected with high sensitivity and specificity by immunohistochemistry (IHC). 8,9 Although conventional forms of PC are relatively easy to diagnose on FNA, metastatic disease may display variant morphology which can complicate the diagnosis. Such variant morphology may exhibit uncommon histologic variants of PC (e.g., ductal, squamous cell) or morphologic phenotypes (pro-proliferative, neuroendocrine) reflective of lineage plasticity developing as a manifestation of therapeutic pressure and/or treatment resistance.…”

Section: Introductionmentioning

confidence: 99%

“…Nuclei are usually round and uniform, with easily identified single central prominent nucleoli. Acinar arrangements of tumor cells can be appreciated, both within larger groups and as individual follicle‐like structures 8,9 . The unique immunohistochemical profile of prostate cancer (PC) aids the FNA diagnosis when needed.…”

Section: Introductionmentioning

confidence: 99%

“…Conventional forms of PC usually express PSA, prostate‐specific membrane antigen (PSMA), NK3 Homeobox1 (NKX3.1), and androgen receptor (AR). Erythroblast transformation‐specific‐related gene protein ( ERG ) rearrangements are common early in prostate cancer development and can be detected with high sensitivity and specificity by immunohistochemistry (IHC) 8,9 …”

Section: Introductionmentioning

confidence: 99%

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Metastatic prostate cancer diagnosed by fine‐needle aspiration: Contemporary cytopathologic and biomarker assessment with clinical correlates

Cantley

Wang

Reichert

et al. 2022

Cancer Cytopathology

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Introduction The diagnosis of metastatic prostatic cancer (MPC) by fine needle aspiration (FNA) can usually be rendered by typical cytomorphologic and immunohistochemical (IHC) features. However, MPC diagnosis may be complicated by transformation to atypical phenotypes such as small cell carcinoma, typically under pressure from androgen deprivation therapy (ADT). Predictive and prognostic biomarkers can also be assessed by IHC. This study illustrates how careful assessment of cytologic and biomarker features may provide therapeutic and prognostic information in MPC. Design We reviewed our anatomic pathology archives for MPC diagnosed by FNA from January 2014 to June 2021. Clinical histories, cytology slides, and cell blocks were reviewed. Extensive IHC biomarker workup was performed, including markers of prostate lineage, cell‐cycle dysfunction, Ki‐67, neuroendocrine markers, PDL1, and androgen receptor splice variant 7. Cases were reclassified into three categories: conventional type, intermediary type, and high‐grade neuroendocrine carcinoma (HGNC). Results Eighteen patients were identified. Twelve had conventional MPC, including six of six ADT‐naive patients. Six of twelve (50%) with prior ADT were reclassified as intermediary or HGNC. Four intermediary cases included two with squamous differentiation and two with pro‐proliferative features. Two HGNC cases had typical small cell carcinoma cytomorphology. Expression of PDL1 was identified in two cases and ARv7 in three cases. Five of five intermediary and HGNC patients died of disease versus six of eleven with with conventional type. Conclusions Aggressive cytomorphologic variants were commonly identified in patients with prior ADT. Identification of nonconventional cytomorphology and increased proliferation can provide important prognostic information. Recognition of these changes is important for an accurate diagnosis, and the identification of high‐grade variants can affect therapeutic decision‐making. Clinically actionable biomarkers such as PDL1 and ARv7 can be assessed by IHC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Metastatic prostate cancer diagnosed by fine‐needle aspiration: Contemporary cytopathologic and biomarker assessment with clinical correlates

Cantley

Wang

Reichert

et al. 2022

Cancer Cytopathology

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“…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 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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Cervical lymphadenopathy as the initial presentation of metastatic prostate cancer is particularly uncommon, and easily misdiagnosed. In the current study, we describe five cases of metastatic prostate cancer in our hospital that presented with cervical lymphadenopathy as an initial symptom. The diagnosis was confirmed by needle biopsy of the suspicious lymph nodes and the serum prostate specific antigen (PSA) levels of all patients exceeded 100 ng/ml. The five patients were treated with hormonal therapy; four received traditional hormonal therapy, including bicalutamide and goserelin; one patient received hormonal therapy that included abiraterone and goserelin. Case 1 developed into castration-resistant prostate cancer (CRPC) after 7 months and died after 12 months. Case 2 rejected regular hormonal therapy for personal reasons and died 6 months after the initial diagnosis. Case 3 was still alive at the time of writing. Case 4 was administered with abiraterone, prednisolone and goserelin; the treatment was effective and the patient has remained symptom-free for the last 24 months. Case 5 was treated with hormonal and chemotherapy but died 8 months after diagnosis. In conclusion, any elderly male presenting with cervical lymphadenopathy should be considered the possibility of prostate cancer, especially when the needle biopsy reveals adenocarcinoma. The prognosis for patients presented with cervical lymphadenopathy as the initial presentation is usually poor. Hormone therapy based on abiraterone may yield a better response in such cases.

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Supraclavicular metastasis from prostate cancer: unusual case and literature review

Ascio

Qureshi

Banayan

et al. 2023

Journal of Surgical Case Reports

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Prostate cancer is the most common cancer among men, with the most common metastatic sites in bone, regional lymph nodes, liver and thorax. It is most commonly diagnosed in the early stages with clinical findings of enlarged prostate on digital rectal exam and positive prostate specific antigen. Distant metastases associated with prostate cancer commonly occur to bone. It is imperative to be cautious in assuming primary breast, lung or head and neck malignancy in patients presenting with lymphadenopathy in the upper aerodigestive pathways. Cervical lymphadenopathy due to prostate cancer is becoming more prevalent since previously reported. Here we present a case of prostate cancer recurrence found through metastasis to supraclavicular lymph nodes and we also highlight homeobox protein CDX2 as a potential clinico-pathological marker in metastatic prostate cancer.

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Metastatic prostate adenocarcinoma to cervical lymph nodes: an unusual diagnosis on fine-needle aspiration biopsy

Cited by 5 publications

References 21 publications

Metastatic prostate cancer diagnosed by fine‐needle aspiration: Contemporary cytopathologic and biomarker assessment with clinical correlates

Metastatic prostate cancer diagnosed by fine‐needle aspiration: Contemporary cytopathologic and biomarker assessment with clinical correlates

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

Supraclavicular metastasis from prostate cancer: unusual case and literature review

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