De novo calcification of liver and nodal metastases in prostate carcinoma

Prostate Cancer and Prostatic Diseases (2006) 9, 448451 & 2006 Nature Publishing Group All rights reserved 1365-7852/06 $30.00 www.nature.com/pcan

CASE REPORT

De novo calcification of liver and nodal metastases in prostate carcinoma

P Ghosh1, AC Santosa2, GY Lin3 and TM Downs4,5

1Department of Internal Medicine, University of California, San Diego, San Diego, CA, USA; 2Department of Radiology, University of California, San Diego, San Diego, CA, USA; 3Department of Pathology, University of California, San Diego, San Diego, CA, USA; 4Department of Surgery (Division of Urology), University of California, San Diego, San Diego, CA, USA and 5VA San Diego Healthcare System, San Diego, CA, USA

Prostate cancer has a distinctly recognized pattern of metastases: multifocal and osteoblastic lesions involving the axial skeleton and non-calcified lymph nodes in the pelvic and lumbar aortic groups. Most adenocarcinomas are capable of producing macrocalcification. We report a case of prostate cancer with de novo calcified metastases to the liver and retroperitoneal lymph nodes mimicking the pattern usually seen in mucin-producing adenocarcinomas arising from the gastrointestinal tract. To our knowledge, this is the first such case to be reported in the literature. We propose a multifactorial mechanism that supports dystrophic calcification in this case. The knowledge of atypical presentation of metastatic disease can prevent diagnostic delay and prompt initiation of therapy.

Prostate Cancer and Prostatic Diseases (2006) 9, 448451. doi:10.1038/sj.pcan.4500875; published online 9 May 2006 Keywords: prostate cancer; calcification; metastases; PSA; adenocarcinoma; calcified metastasis; unknown primary

Case report

A 61-year-old man presented to the emergency room with obstructive uropathy, generalized lymphadenopathy, liver mass and an elevated prostate-specific antigen (PSA) of 670 ng/ml. He was apparently healthy until 6 months prior when he noted progressive fatigue, weight loss of 30 pounds, loss of appetite and occasional nausea and vomiting that became more frequent in the 3 weeks before his presentation to the emergency room. Two months before admission he developed urinary hesitancy, frequency, urgency and bilateral flank pain. At the same time, he also noted a painless swelling in his right groin that progressively increased in size. The patient had no significant past medical history and had not sought routine primary health care during the last 10 years and had no prior prostate or colon cancer screening. His social history was significant for...