Prostate metastases - widespread

Case contributed by A.Prof Frank Gaillard

Presentation

Very delirious and very watery constant bowel movements.

Patient Data

Age: 80 years
Gender: Male
X-ray

Chest and abdominal x-rays

Chest x-ray demonstrates very widespread pulmonary nodules. 

Abdominal x-ray reveals mixed destructive lytic and sclerotic pelvic changes on the left. 

CT

CT abdomen and pelvis

There is diffuse abnormality of the distal colon, sigmoid colon and rectum, characterised by bowel wall thickening and peri-colonic fat stranding.  This occurs in the region of presumed radiotherapy treatment and would be consistent, in this setting, with radiation colitis.  The more proximal large and small bowel loops are prominent suggesting a degree of functional obstruction.

Small, low attenuation nodular lesions are seen within the valvular commitantes of several loops of small bowel.  These may represent nodules from metastases, although this is somewhat unusual in the setting of prostate cancer.  Other non-metastatic nodules such as polyps or alternatively hamartomas are also considered on the differentiation.  Correlation to any previous imaging would be of use.

Multiple liver lesions are identified involving both lobes of liver, with low attenuation and ill-defined margins.  Similarly, multiple pulmonary lesions are identified consistent with multiple metastases.  Small pleural effusions.  Small rounded lymph nodes are demonstrated lying to the left of the L5 vertebral body.

Large retroperitoneal lipoma measuring approximately 11cm in diameter, with vessels seen to coarse through this region.  

The pancreas, adrenals and kidneys are normal with small cortical cysts seen within the kidneys but no evidence of hydronephrosis.  Bilateral fat containing inguinal hernias, with multiple prominent lymph nodes demonstrated within the left inguinal region, the largest of which has a short axis diameter of 1.5cm.  

Review of the bones demonstrates mixed sclerotic and lucent lesion involving most of the left hemipelvis consistent with malignant disease.  A further soft tissue deposit is demonstrated within the coccyx/distal sacrum measuring approximately 4.2 x 2.8cm.  Subtle sclerosis in the L4 vertebral body extending into the posterior elements are suspicious for further metastatic disease.  An IDC is demonstrated within a contracted bladder which has some mild thickening and some hyperdensity in the dependent portions which may represent radiation cystitis and clinical correlation is recommended.

Case Discussion

This 80 year old man with known metastatic prostate carcinoma was receiving radiotherapy to left hemipelvis.  

Diffuse bowel wall thickening involving the rectum, sigmoid colon and distal colon consistent with radiation colitis in the setting of radiation to the region.  There is prominence of the large bowel and small bowel loops which may reflect a degree of functional obstruction.  Skeletal lesions, liver lesions and multiple lung lesions are noted.  This is somewhat unusual for prostate cancer, but can occur.  Several small well-defined low density nodules seen within the valvular commitantes of small bowel loops is noted.  Possible metastases from the primary is considered, but is very unusual and other non-malignant lesions such as small polyps or alternatively, small hamartomas is considered on the differential. 

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Case information

rID: 15215
Case created: 2nd Oct 2011
Last edited: 7th Nov 2015
Inclusion in quiz mode: Included

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