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KMID : 0939920090410010045
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대한암학회지
2009 Volume.41 No. 1 p.45 ~ p.49
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Cancer of Unknown Primary Finally Revealed to Be a Metastatic Prostate Cancer: A Case Report
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Cho Jung-Yeon
Shim Eun-Jin
Kim In-Seon
Nam Eun-Mi
Choi Moon-Young
Lee Kyong-Eun
Mun Yeung-Chul
Seoung Chu-Myoung
Lee Soon-Nam
Song Dong-Eun
Han Woon-Sup
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Abstract
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The vast majority of patients with metastatic prostate cancer present with bone metastasesand high prostate specific antigen (PSA) level. Rarely, prostate cancer can develop inpatients with normal PSA level. Here, we report a patient who presented with a periureteraltumor of unknown primary site that was confirmed as prostate adenocarcinoma after threeyears with using specific immunohistochemical examination. A 64-year old man wasadmitted to our hospital with left flank pain associated with masses on the left pelvic cavitywith left hydronephrosis. All tumor markers including CEA, CA19-9, and PSA were within thenormal range. After an exploratory mass excision and left nephrectomy, the pelvic mass wasdiagnosed as poorly differentiated carcinoma without specific positive immunohistochemicalmarkers. At that time, we treated him as having a cancer of unknown primary site. Afterapproximately three years later, he revisited the hospital with a complaint of right shoulderpain. A right scapular mass was newly detected with a high serum PSA level (101.7 ng/ml).Tissues from the scapular mass and prostate revealed prostate cancer with positiveimmunoreactivity for P504S, a new prostate cancer-specific gene. The histological findingswere the same as the previous pelvic mass; however, positive staining for PSA was observedonly in the prostate mass. This case demonstrates a patient with prostate cancer andnegative serological test and tissue staining that turned out to be positive during progression.We suggest the usefulness of newly developed immunohistochemical markers such as P504S todetermine the specific primary site of metastatic poorly differentiated adenocarcinoma in men.
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KEYWORD
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P504S, Metastatic prostate cancer, Cancer of unknown primary
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