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. 2020 Jul-Sep;61(3):751-758.
doi: 10.47162/RJME.61.3.13.

Prostate carcinomas mimicking a digestive malignancy

Sorin Dema  1 , Alis Liliana Carmen Dema, Sorina Tăban, Bianca Roxana Natarâş, Livius Cosmin Daminescu, Ciprian Constantin Duţă, Alin Adrian Cumpănaş, Tiberiu Răzvan Bardan
Affiliations

Prostate carcinomas mimicking a digestive malignancy

Sorin Dema et al. Rom J Morphol Embryol. 2020 Jul-Sep.

Abstract

Aim: To report our experience with specific cases of prostate cancer (PC) in which patients presented digestive symptoms, cases that represent a challenge and a source of error regarding the clinical and morphological diagnosis.

Methods: The most important clinical and pathological data were collected from three patients with PC which presented symptoms and/or investigations that initially suggested a digestive malignant tumor.

Results: We identified three patients with PC where the prostate tumor was not suspected based on the clinical-imagistic data, the correct diagnosis being the prerogative of the morphological investigation: in the first case, PC was detected during the microscopic examination of the lymph nodes (LN) in the intestinal resection specimen performed for suspected rectal cancer (RC), in the second case, in which the PC was synchronous with a RC, the dominant symptomatology was gastrointestinal, and in the third case, initially, the patient presented a widely disseminated PC, with pleural and bone metastases, as well as LN metastases, and apparent peritoneal involvement.

Conclusions: Unusual forms of PC presentation are not as rare as expected and should be acknowledged by all those involved in diagnosing this neoplasm. PC should always be considered in the differential diagnosis of a rectal tumor. The immunohistochemical (IHC) investigation is essential for establishing the diagnosis in difficult cases. An integrated approach of the interpretation of clinical manifestations, imagistic and serological changes would shorten the diagnostic time and help reduce diagnostic errors.

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Two of the three cases were briefly presented at the 30th European Congress of Pathology, Bilbao, Spain [E-PS-24-036: Dema A, Taban S, Anderco D, Georgescu G, Lazureanu C, Bardan R, Cumpanas A, Dema S. Atypical presentation of prostate carcinoma. Virchows Arch, 2018, 473(Suppl 1):S334. https://doi.org/10.1007/s00428-018-2422-1; https://link.springer.com/content/pdf/10.1007/s00428-018-2422-1.pdf], but in the present paper the two cases are more detailed, with additional data on the history and evolution of the disease.

Figures

Figure 1
Figure 1
Microscopic findings of the first case: (A) Tubular adenomatous polyp with low grade dysplasia and (B) lymph node metastasis from a prostatic adenocarcinoma, diagnosed in the rectal resection specimen; (C) Positive reaction for PSA within the metastatic deposits in the perirectal lymph node; (D) Subsequently confirmed prostatic carcinoma on core-needle biopsy. HE staining: (A and D) ×200; (B) ×100. Anti-PSA antibody immunomarking: (C) ×100. HE: Hematoxylin–Eosin; PSA: Prostate specific antigen
Figure 2
Figure 2
Histopathological features of the second case: (A) Moderately differentiated intestinal adenocarcinoma of the rectum in the resection specimen; (B) Tumor cells showed focal positive reaction for CK20; (C) Simultaneously, the intestinal wall was invaded by a prostatic adenocarcinoma composed of poorly formed/fused glands and individual infiltrative cells, with (D) positive reaction for PSA. HE staining: (A) ×100; (C) ×200. Anti-CK20 antibody immuno-marking: (B) ×200. Anti-PSA antibody immunomarking: (D) ×100. CK20: Cytokeratin 20; HE: Hematoxylin–Eosin; PSA: Prostate specific antigen
Figure 3
Figure 3
Microscopic features of the third case: (A) Histopathological aspects of prostate acinar adenocarcinoma (Gleason score 9 = 5+4, grade group 5) with (B) extraprostatic extension; (C) Tumor cells with positive reaction for PSA and (D) nuclear staining for NKX3.1. HE staining: (A and B) ×400. Anti-PSA antibody immunomarking: (C) ×400. Anti-NKX3.1 antibody immunomarking: (D) ×400. HE: Hematoxylin–Eosin; PSA: Prostate specific antigen
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