背景:前列腺癌是尼日利亚最常见的男性恶性肿瘤,也是全球第二常见的男性恶性肿瘤。患者经常出现局部进展阶段,常见的转移部位是脊柱,骨盆,胸部,和长骨。睾丸和精索的转移被认为是罕见的,可能是一个更糟糕的结果,当他们发生。我们最近遇到了一个双侧睾丸的临床病例,附睾和精索前列腺癌转移。
方法:一名71岁的尼日利亚男子,他在我们医院出现了1个月大的无法行走的投诉,并伴有腰部和双侧大腿疼痛。在出现这种情况之前,有5个月的下尿路症状史。在检查中,前列腺坚硬,结节状,左侧睾丸和精索也是如此。在穿刺活检的组织学评估中,诊断为前列腺腺癌(Gleason评分5+5=10)。发现随后的治疗性双侧全睾丸切除术标本中含有转移性前列腺癌沉积物,在睾丸中,附睾,和精索。尽管我们的患者目前在唑来膦酸治疗后表现良好,酮康唑,比卡鲁胺,还有坦索罗辛,他正在定期重新评估任何复发的特征。
结论:由于它对最终结果有影响,每个临床上可疑的治疗性睾丸切除术标本都应接受详细的组织病理学检查,以排除原发性前列腺恶性肿瘤的继发性病变。
BACKGROUND: Prostatic carcinoma is emerging as the most common male malignancy in Nigeria and the second most common male cancer worldwide. Patients often present with locally advances stages, and common sites of metastasis are the spine, pelvis, chest, and long bones. Metastases to the
testes and spermatic cords are reputed to be rare and may be indicative of a worse outcome, when they occur. We recently encountered a clinical
case of bilateral testicular, epididymal and spermatic cords prostatic cancer metastases.
METHODS: A 71-year-old Nigerian man, who presented at our hospital with 1-month-old complaints of inability to walk together with low back and bilateral thigh pains. This presentation had been preceded by a 5-month history of lower urinary tract symptoms. On examination, the prostate was hard and nodular as were the left testis and spermatic cord. On histological assessment of a needle biopsy, prostatic adenocarcinoma (Gleason score 5 + 5 = 10) was diagnosed. A subsequent therapeutic bilateral total orchidectomy specimen was found to contain metastatic prostatic carcinoma deposits, in the
testes, epididymides, and spermatic cords. Although our patient is currently doing well postoperatively on zoledronic acid, ketoconazole, bicalutamide, and tamsulosin, he is being re-evaluated periodically for any feature of recurrence.
CONCLUSIONS: Since it has implications for eventual outcome, every clinically suspicious therapeutic orchidectomy specimen should be subjected to a detailed histopathological examination in order to exclude secondaries from the primary prostatic malignancy.