Case Report
Volume 3 Issue 3 - 2020
Unusual Presentation of De Novo Case of Prostate Adenocarcinoma with Diffuse Neuroendocrine Differentiation
Aisha Hasan1, Naima Tariq2, Nadeem Iqbal3*, Syed Salman Shah4, Muhammad Athar Khawaja5, Ali Mohsin Choudhry3, Nomah Mahnoor6, Sidra Ali Naqvi6 and Saeed Akhter3
1Faculty, Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan
2Department of Pathology, Shifa International Hospital, Islamabad, Pakistan
3Department of Urology, Shifa International Hospital, Islamabad, Pakistan
4PhD Scholar, Department of Physiology, Khyber Medical University, Pakistan
5Consultant Urology, Department of Urology, Shifa International Hospital, Islamabad, Pakistan
6Department of Physical Therapy and Rehabilitation, Shifa International Hospital, Islamabad, Pakistan
*Corresponding Author: Nadeem Iqbal, Department of Urology and Kidney Transplant, Pakistan Kidney Institute, Shifa International Hospital, Islamabad, Pakistan.
Received: February 06, 2020; Published: February 27, 2020




Abstract

The interest regarding neuroendocrine prostate cancer has widened in the last few years as many of these cases were seen coinciding with the accelerated utilization of androgen deprivation therapy, and thus the possible association between androgen deprivation therapy and neuroendocrine prostate cancer was hypothesized. Even though, androgen deprivation therapy is considered to be the main culprit associated with neuroendocrine prostate cancer, there have been few rare cases that had no prior history of androgen deprivation therapy use in their past. We report here an unusual presentation of de novo case of prostate adenocarcinoma with diffuse neuroendocrine differentiation. An elderly male of 59-year-old presented to our clinic with an enlarged lymph node on left side of neck. Physical examination showed soft abdomen and no visceromegaly, spine was non tender. An excisional biopsy of the lymph node was sent for histopathological examination depicting diffuse effacement of the lymph node architecture by a metastatic tumor comprised of cribriform glands. Immunohistochemical markers were applied to delineate the primary site which showed that the tumor was negative for CK7 and CK20, however prostate specific antigen and prostatic specific acid phosphatase displayed diffuse positivity. In addition, since many cells showed nuclear molding therefore synapophysin and chromgranin were also applied and both of them displayed extensive granular cytoplasmic positivity. Based on these findings a final diagnosis of metastatic prostatic adenocarcinoma with diffuse neuroendocrine differentiation was rendered. Later on, Trans rectal ultrasonography biopsy was performed from all six lobes which showed Grade 5 (Gleason score 4+5) tumor in five out of 6 cores. These tumor cells also displayed strong cytoplasmic staining for synaptophysin and chromogranin highlighting their neuroendocrine differentiation. Only few such cases have been reported in literature and information regarding its clinicopathological features and disease outcome are limited. Our case was a challenging and insightful to add to the literature regarding this rare presentation of prostate cancer. 

Keywords: Prostate Cancer; Cervical Lymphadenopathy; Metastasis; Neuroendocrine

References

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  3. Raquel Civolani Marques Marcus de Medeiros., et al. “Prostate carcinoma with neuroendocrine differentiation: case report and literature review”. Revista do Hospital das Clínicas 56 (2001): 153-158.
  4. Mehdi Kardoust Parizi., et al. “Differentiation of Conventional Prostate Adenocarcinoma as a Prognostic Factor after Radical Prostatectomy: A Systematic Review and Meta-Analysis”. International Journal of Molecular Sciences 20.6 (2019): 1374.
  5. Jonathan I Epstein., et al. “Proposed Morphologic Classification of Prostate Cancer With Neuroendocrine Differentiation”. American Journal of Surgical Pathology 38.6 (2014): 756-767.
  6. Lin D., et al. “High fidelity patient-derived xenografts for accelerating prostate cancer discovery and drug development”. Cancer Research 74.4 (2014): 1272-1283.
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Citation: Aisha Hasan., et al. “Unusual Presentation of De Novo Case of Prostate Adenocarcinoma with Diffuse Neuroendocrine Differentiation”. EC Clinical and Medical Case Reports 3.3 (2020): 01-06.

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