J Pathol Transl Med.  2018 Jul;52(4):257-261. 10.4132/jptm.2018.05.08.

Malignant Pleural Effusion from Metastatic Prostate Cancer: A Case Report with Unusual Cytologic Findings

Affiliations
  • 1Department of Hospital Pathology, Seoul St. Mary’s Hospital, Seoul, Korea. leekyoyo@catholic.ac.kr
  • 2Department of Hospital Pathology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

We present a case of 55-year-old man who complained of dyspnea and sputum for a month. He was an ex-smoker with a history of prostate cancer and pulmonary tuberculosis. Chest radiographs revealed bilateral pleural effusions of a small to moderate amount. Pigtail catheters were inserted for drainage. The pleural fluid consisted of large clusters and tightly cohesive groups of malignant cells, which however could not be ascribed to prostate cancer with certainty. We performed immunocytochemical panel studies to determine the origin of cancer metastasis. The immunostaining results were positive for prostate-specific antigen, alpha-methylacyl-coenzyme A racemase, and Nkx 3.1, consistent with prostate cancer. Pleural effusion associated with prostate cancer is rare. To our knowledge, this is the first case report in Korea to describe cytologic features of malignant pleural effusion associated with prostate cancer.

Keyword

Prostatic neoplasms; Neoplasm metastasis; Pleural effusion, malignant

MeSH Terms

Catheters
Drainage
Dyspnea
Humans
Korea
Middle Aged
Neoplasm Metastasis
Pleural Effusion
Pleural Effusion, Malignant*
Prostate*
Prostate-Specific Antigen
Prostatic Neoplasms*
Radiography, Thoracic
Sputum
Tuberculosis, Pulmonary
Prostate-Specific Antigen

Figure

  • Fig. 1. Radiologic findings of the patient. (A) The tumor appears to replace most of the prostate and spread to perirectal area and bilateral pelvic wall on contrast-enhanced computed tomography. Extensive regional lymphadenopathy is observed (arrow). The chest X-ray reveals bilateral pleural effusions of a small to moderate amount (B) with a larger amount on the right side (C).

  • Fig. 2. Cytologic features of Papanicolaou smears (A–C), the cell block (D–F) and the result of immunocytochemical staining (G–I). (A) It shows a sheet-like cell group. (B) A large cell-cluster is noted, forming three-dimensional ball. Hyperchromatic nuclei and high nuclear to cytoplasmic ratio are also observed. (C) The tumor cells have coarse, finely granular and vesicular chromatin. (D) The majority are in tightly cohesive groups of cells. (E) Some groups have the glandular lumen-like structure with central necrosis. Tumor cells are immunopositive for prostate-specific antigen (F), alpha-methylacyl-coenzyme A racemase (G), and Nkx 3.1 (H). (I) They show negative immunoreactivity for cytokeratin 5/6.

  • Fig. 3. The histological characteristics of transurethral resection of the prostate specimen. (A) The hematoxylin and eosin stained section shows a poorly differentiated carcinoma. (B) Lymphovascular invasion is observed with the tumor emboli forming well-demarcated ovoid masses.


Reference

1. Egan AM, McPhillips D, Sarkar S, Breen DP. Malignant pleural effusion. QJM. 2014; 107:179–84.
Article
2. Thomas JM, Musani AI. Malignant pleural effusions: a review. Clin Chest Med. 2013; 34:459–71.
3. Lim MH, Garrettc J, Mowlem L, Yap E. Diagnosing malignant pleural effusions: how do we compare? N Z Med J. 2013; 126:42–8.
4. Bubendorf L, Schopfer A, Wagner U, et al. Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients. Hum Pathol. 2000; 31:578–83.
Article
5. Vinjamoori AH, Jagannathan JP, Shinagare AB, et al. Atypical metastases from prostate cancer: 10-year experience at a single institution. AJR Am J Roentgenol. 2012; 199:367–72.
Article
6. Ani I, Costaldi M, Abouassaly R. Metastatic prostate cancer with malignant ascites: a case report and literature review. Can Urol Assoc J. 2013; 7:E248–50.
Article
7. Bajpai PA, Joshi P, Joseph D, Bajpai A. A case of recurrent massive right sided pleural effusion-an unusual presentation of carcinoma prostate. Lung India. 2014; 31:423–4.
Article
8. dos Santos VM, Zembrzuski MM, Gouvea IP, Nery NS, dos Santos LA. Massive pleural effusion due to metastasis of prostate cancer. West Indian Med J. 2011; 60:690–3.
9. Knight JC, Ray MA, Benzaquen S. Malignant pleural effusion from prostate adenocarcinoma. Respir Med Case Rep. 2014; 13:24–5.
Article
10. Saif MW. Malignant ascites associated with carcinoma of the prostate. J Appl Res. 2005; 5:305–11.
11. Saif MW, Figg WD, Hewitt S, Brosky K, Reed E, Dahut W. Malignant ascites as only manifestation of metastatic prostate cancer. Prostate Cancer Prostatic Dis. 1999; 2:290–3.
Article
12. Mai KT, Roustan Delatour NL, Assiri A, Al-Maghrabi H. Secondary prostatic adenocarcinoma: a cytopathological study of 50 cases. Diagn Cytopathol. 2007; 35:91–5.
Article
13. Renshaw AA, Nappi D, Cibas ES. Cytology of metastatic adenocarcinoma of the prostate in pleural effusions. Diagn Cytopathol. 1996; 15:103–7.
Article
14. Carrascosa M, Perez-Castrillon JL, Mendez MA, Cillero L, Valle R. Malignant pleural effusion from prostatic adenocarcinoma resolved with hormonal therapy. Chest. 1994; 105:1577–8.
Article
15. Shimizu T, Shibata Y, Uchida T, Satoh J. Severe flare-up in a prostate cancer patient treated with luteinizing hormone-releasing hormone analogue depot. Hinyokika Kiyo. 1993; 39:953–5.
16. Mestitz H, Pierce RJ, Holmes PW. Intrathoracic manifestations of disseminated prostatic adenocarcinoma. Respir Med. 1989; 83:161–6.
Article
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