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Abstract

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Article in Japanese

Case Report

A case of pulmonary metastasis of prostate cancer presenting neuroendocrine differentiation

Yosuke Hurukawaa  Yuu Haraa,b  Masaharu Shinkaia  Hideto Gotoa  Masako Hoshinoa  Keisuke Watanabea  Nobuhiro Yamaguchia  Akihiko Kawanab  Yoshiaki Ishigatsuboc  Takeshi Kanekoa 

aRespiratory Disease Center, Yokohama City University Medical Center
bDivision of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine 2, National Defense Medical College
cDepartment of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine

ABSTRACT

The case involves a 71-year-old man. In July 2007, he began receiving maximum androgen blockade (MAB) therapy at the urology department of his neighboring hospital because of prostate cancer. Serum PSA level was normalized by February 2009, but in February 2010 he began to suffer from dry cough. He was admitted to our hospital in May 2010 because chest radiography revealed a mass lesion in the left lung. A transbronchial tumor biopsy specimen showed small cell carcinoma. Despite a normal serum PSA level, however, prostate involvement enlarged and serum neuron-specific enolase (NSE) level elevated in response to MAB therapy. Immunohistochemical staining of lung biopsy and post-MAB prostate specimens were performed, and they revealed synaptophysin (+) with the feature of a neuroendocrine tumor. Because the immunohistochemical staining of the pre-MAB prostate specimen showed synaptophysin (-), we concluded that prostate cancer had undergone neuroendocrine differentiation after MAB therapy, and pulmonary metastasis occurred through the clinical course. After diagnosis, the patient was administered cisplatin and irinotecan. Pulmonary involvement was significantly improved, and serum NSE level was normalized. On the appearance of a small cell carcinoma in the lung during MAB therapy in a case of prostate cancer, neuroendocrine differentiation of the prostate cancer should be considered as the possible primary lesion.

KEYWORDS

Prostate cancer  Neuroendocrine differentiation  Metastatic lung tumor  Small cell carcinoma 

Received 30 Sep 2011 / Accepted 15 Feb 2012

AJRS, 1(6): 481-486, 2012

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