Metastatic prostate cancer (bone scan)
Oncology clinics follow-up.
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Whole body bone scan was performed. There are multiple foci of abnormal uptake throughout the skeleton, e.g. right acromion, bilateral scapulae, multiple ribs bilaterally (especially left 9th rib), thoracolumbar spine at multiple levels (especially mid- thoracic spine), bilateral bony pelvis and right femoral neck.
Widespread osteoblastic bone metastases.
MICROSCOPIC DESCRIPTION: Sections show bony trabeculae and fibrous connective tissue extensively infiltrated by solid sheets, cribriform glands and single tumour cells containing pale cytoplasm, round nuclei and prominent nucleoli. Areas of tumour cell necrosis are present. No lymphovascular or perineural invasion is seen. Immunohistochemical results show tumour cells stain: PSA+, PSAP+, AMACR+, TTF1 focal+, CK7-, CK20-, CDX2- and Tyrosinase-. The features are those of metastatic prostatic acinar adenocarcinoma, Gleason score 5+4=9. No small cell component is seen.
DIAGNOSIS: Thoracic spine: Metastatic prostatic acinar adenocarcinoma; Gleason score 5+4=9.