Small cell carcinoma of the prostate

Primary malignancy/clinical concern:

Large heterogenous trans-spatial mass centered in the pelvis, which invades through the mesorectum into the rectum and also into the bladder. The prostate and seminal vesicles are presumably engulfed in the mass. Moderate bilateral hydroureteronephrosis.

Significant mass effect within the pelvis - bilateral common iliac veins are obliterated at the level of the mass. Non-occlusive filling defects can be seen within bilateral common femoral veins (left worse than right) and the left renal vein, consistent with thrombus. Multiple pulmonary emboli are also noted.

Lymph nodes:

Heterogenous conglomerate lymphadenopathy affects the common iliac and pelvic sidewall stations. Pathologic lymphadenopathy in retropubic, para-aortic, bilateral hilar, and mediastinal stations.

Metastases:

Pulmonary bases: multiple rounded lung lesions suspicious for metastases.

Liver: multiple hypodense lesions suspicious for metastases.

Osseous: irregularity of the inferior left pubic ramus cortex with a lytic lesion and adjacent soft tissue component; suspicious for metastasis. There was no other bony lesion.

Normal adrenal glands. No ascites or pleural effusion.

Marked interval progression of disease. The patient now has ongoing bilateral leg pain but no other neurology. No spinal metastatic disease or canal compromise; however, the mass and its nodal metastases are invading the anterior surface of the psoas muscles bilaterally and may be involving nerves arising from the lumbar plexus.