Abstract
BackgroundProstatic carcinoma is the second most common cause of cancer-related deaths in males in the West. Approximately 20% of patients present with metastatic disease. We describe the case of a patient with metastatic prostate cancer to the bowel presenting clinically and radiologically as a primary caecal cancer.Case presentationA 72 year-old man presented with abdominal discomfort and a clinically palpable caecal mass and a firm nodule on his thigh, the latter behaving clinically and radiologically as a lipoma. Computed tomographic (CT) scan showed a luminally protuberant caecal mass with regional nodal involvement. The patient was being treated (Zoladex®) for prostatic cancer diagnosed 6 years previously and was known to have bony metastases. On admission his PSA was 245.4 nmol/ml. The patient underwent a right hemicolectomy. Histology showed a poorly differentiated adenocarcinoma which was PSA positive, confirming metastatic prostatic adenocarcinoma to the caecum. The patient underwent adjuvant chemotherapy and is free from recurrence a year later.ConclusionMetastasis of prostatic carcinoma to the bowel is a very rare occurrence and presents a challenging diagnosis. The diagnosis is supported by immunohistochemistry for PSA. The treatment for metastatic prostate cancer is mainly palliative.
Highlights
Prostatic carcinoma is the second most common cause of cancer-related deaths in males in the West
We describe the case of a patient with metastatic prostate cancer to the bowel presenting as primary caecal cancer
A 72-year-old man presented with abdominal discomfort with small amount of bleeding per rectum and a clinically palpable lump in the right iliac fossa
Summary
Prostatic carcinoma is the second most common cause of cancer related deaths in males in the West [1]. We describe the case of a patient with metastatic prostate cancer to the bowel presenting as primary caecal cancer. A 72-year-old man presented with abdominal discomfort with small amount of bleeding per rectum and a clinically palpable lump in the right iliac fossa. He had a large, firm, mobile lump on his left thigh. Clinical examination showed a 6 cm hard, mobile, nontender mass in his right iliac fossa. Histopathological examination of the specimen showed a poorly differentiated adenocarcinoma of the caecum extending throughout the whole bowel wall and breaching the serosa with metastatic involvement of 5 of 15 paracolic lymph nodes (Figure 2). The patient underwent adjuvant chemotherapy with Docetaxel and Paclitaxel and is free from recurrence a year later
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