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Lung Cancer |

Neck Swelling and Prostate Cancer...Can They Be Related?

Muhammad Khawar, MD; Minh Phan, MD; Tauseef Ali, MD
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Internal Medicine, Oklahoma University Health Sciences Center, Oklahoma City, OK


Chest. 2014;146(4_MeetingAbstracts):654A. doi:10.1378/chest.1990833
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Abstract

SESSION TITLE: Cancer Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Prostate adenocarcinoma commonly metastasizes to the axial skeleton, lungs, and liver. Isolated metastasis to the thyroid gland is rare. We describe a patient with a sudden onset of neck swelling accompanied by clinical features of Superior Vena Cava Syndrome (SVCS), who later was found to have thyroid metastasis from prostate adenocarcinoma.

CASE PRESENTATION: A 73-year-old male with a past medical history significant for hypertension and bipolar disorder, presented with the complaint of neck swelling, shortness of breath and hoarseness of voice. His symptoms started suddenly a few weeks back and accompanied by dysphagia to solid foods. The patient did not report any fever, chills, cough, hemoptysis, nausea/vomiting, change in appetite, weight loss, altered bowel movements, or dysuria. He had a 50 pack-year smoking history and a recovered alcoholic. Initial vital signs were stable and on physical examination, he had a moderate to large size swelling in the anterior part of the neck, palpable cervical and supraclavicular lymphadenopathy with telangiectasia and visible veins on the anterior neck. The Ultrasound of thyroid and soft tissue neck showed enlarged thyroid gland with no discrete nodules and multiple soft tissue masses/lymph nodes in the neck. Chest computed tomography (CT) showed small bilateral pleural effusion, cervical, supraclavicular and mediastinal lymphadenopathy, non-specific thyromegaly, and early side-to-side narrowing of the airways. Next, an Ultrasound guided fine needle aspiration & biopsy of thyroid gland and lymph nodes was done. The pathology came back positive for immunostaining with PSA and prostatic acid phosphatase; this was consistent with metastatic poorly differentiated adenocarcinoma of the prostate.

DISCUSSION: Prostate Cancer is the most common malignancy in men and the second leading cause of cancer-related deaths. Prostate cancer with solitary metastasis to the thyroid gland and causing SVCS is very rare, to date there have been only six documented cases in the published literature. Patients presenting with a neck mass are commonly presumed to have a thyroid malignancy, less often is metastatic prostate cancer included in the differential diagnosis. Approximately 10-15% of patients with prostate cancer present with metastatic disease at the time of diagnosis.

CONCLUSIONS: Our case demonstrates that prostate cancer has the ability to uncommonly metastasize to the thyroid gland with neck swelling and SVCS being the sole clinical manifestation.

Reference #1: Albsoul N, Obeidat F, Azmy H, et al. Isolated Multiple Bilateral Thyroid Metastases from Prostatic Adenocarcinoma: Case Report and Literature Review. Endocr Pathol (2013) 24:36-39

DISCLOSURE: The following authors have nothing to disclose: Muhammad Khawar, Minh Phan, Tauseef Ali

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