Urothelial and Prostate Carcinoma Metastasizing to the Same Lymph Node

Abstract

We report herein a case of a collision tumor composed of high-grade urothelial carcinoma and a Gleason grade 3+4 prostate adenocarcinoma metastasizing to the same lymph node. After the patient underwent cystoprostatectomy for known urothelial carcinoma, he was incidentally discovered to have a second primary prostate tumor. Lymph node examination revealed that one node appeared to have metastatic foci from both primary tumors. The presence of 2 tumor types colliding in the same lymph node was confirmed using immunohistochemical stains, including monoclonal carcinoembryonic antigen, prostate-specific antigen, prostatic acid phosphatase, cytokeratins 7 and 20, and CD57. We also stained both primary tumors with the same panel as an internal control. Although 2 similar collision tumors have been reported in the literature in the past, neither used a battery of immunohistochemical stains to definitively distinguish one tumor from the other. Herein, we review the literature on urothelial and prostate collision tumors and some of the special stains used to distinguish them.

Collision nodal metastasis of bladder cancer and melanoma: The first reported case and literature review

“…Subsequent reports pointed out that the diagnosis of colliding tumor in a lymph node could be suspected on a morphologic basis in a patient known to have 2 synchronous tumors. [1,5,8] However, as in our case, a clear diagnosis can be achieved only by proper immunohistochemical staining. [7,10,12] Possible explanations for collision metastases include: 1) involvement of carcinomas which are indolent and common (such as prostate cancer), [5,8] their frequency and long clinical course without any overt clinical symptoms may allow time for second malignancies to develop and metastasize to the same node; 2) an "accidental meeting" of two primary tumors [9] ; 3) a common tumorigenic stimulus triggering neoplastic transformation of both types of cells.…”

“…Age Sex Nodal site Primary tumors Sughayer, 2009 [8] 63 F Axillary Serous papillary ovarian carcinoma Ductal breast carcinoma Saco, 2018 [10] 71 M Axillary Prostate adenocarcinoma Melanoma Pastolero, 1996 [4] 41 M Cervical Papillary thyroid carcinoma Medullary thyroid carcinoma Guelfucci, 2004 [11] 51 M Cervical Papillary thyroid carcinoma Squamous tongue carcinoma Elias da Cruz Perez, 2008 [12] 57 M Cervical Thyroid carcinoma Squamous oral carcinoma Lim, 2008 [13] 47 M Cervical Papillary thyroid carcinoma Squamous tongue carcinoma Mattioli, 2009 [14] 50 F Cervical Papillary thyroid carcinoma Squamous cell carcinoma (unknown origin) Sadat Alavi, 2011 [15] 32 M Cervical Papillary thyroid carcinoma Medullary thyroid carcinoma Zeng, 2012 [16] 49 F Cervical Papillary thyroid carcinoma Ductal breast carcinoma Alhanafy, 2016 [17] 73 F Cervical Papillary thyroid carcinoma Squamous thyroid carcinoma Xu, 2018 [18] 63 M Cervical Papillary thyroid carcinoma Squamous tongue carcinoma Gasparinho, 2011 [19] 55 F Hylar Neuroendocrine rectal carcinoma Ductal breast carcinoma Wade, 2004 [5] (1) 80 M Mesenteric Prostate adenocarcinoma Colonic adenocarcinoma Mourra, 2005 [6] 70 M Mesorectal Prostate adenocarcinoma Rectal adenocarcinoma Terada, 1993 [7] 83 M Para-aortic Prostate adenocarcinoma Stomach adenocarcinoma Ergen, 1995 [2] 67 M Pelvic Prostate adenocarcinoma Urothelial bladder carcinoma Gohji, 1997 [3] 78 M Pelvic Prostate adenocarcinoma Squamous bladder carcinoma Overstreet, 2001 [1] 67 M Pelvic Prostate adenocarcinoma Urothelial bladder carcinoma Bhavsar, 2012 [9] 83 M Pelvic Prostate adenocarcinoma Urothelial bladder carcinoma Wade, 2004 [5] (2) 61 M Perirectal Prostate adenocarcinoma Colonic adenocarcinoma Miyauchi, 2013 [20] 82 M Perirectal Prostate adenocarcinoma Rectal adenocarcinoma El-Gendy, 2008 [21] 51 F Thoracic Oesophageal adenocarcinoma Ductal breast carcinoma Independently of biological behavior and pathogenetic mechanism, collision metastases are thought to carry a poor prognosis probably due to the fact that patients face 2 different metastatic tumors. [13] As a matter of fact, they are clinically relevant because the individual primary tumors may require different treatments once diagnosed as metastatic.…”

Collision metastasis from prostate adenocarcinoma and pancreatic ductal adenocarcinoma to a lung nodule

“…Immunohistochemical staining is invaluable in providing accurate diagnostic confirmation of collision metastasis in all the cases, including the presented case. 1,4,[7][8][9][10][11] Treatment priority would focus on the more significant disease, in this case, recurrent metastatic pancreatic cancer. However, both malignancies of recurrent metastatic pancreatic cancer and castrate resistant metastatic prostate cancer carry poor prognosis.…”

Intracranial Collision Metastases of Small-Cell Lung Cancer and Malignant Melanoma

“…There are several reports of collision metastases involving two primary tumors spreading to the same lymph node. [6][7][8][9] The most common nondermatologic collision tumors involved two urothelial cancers (ie, prostate and bladder) colliding in pelvic lymph nodes. 6 One article documents two cases of prostatic and colorectal carcinomas metastasizing to regional lymph nodes.…”

“…[6][7][8][9] The most common nondermatologic collision tumors involved two urothelial cancers (ie, prostate and bladder) colliding in pelvic lymph nodes. 6 One article documents two cases of prostatic and colorectal carcinomas metastasizing to regional lymph nodes. 7 Many of the described intracranial collision tumors involve a distant tumor spreading to a receiving primary meningioma, although other combinations have been described.…”