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Presented by Dr. Jonathan Epstein and prepared by Dr. Katelynn Davis
Case 1. A 65 year-old man underwent a left supraclavicular lymph node biopsy. There was not history or signs/symptoms suggesting a primary site.
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1. Question
Case 1. A 65 year-old man underwent a left supraclavicular lymph node biopsy. There was not history or signs/symptoms suggesting a primary site.
Choose the correct diagnosis:
Correct
Answer: Metastatic Prostate Cancer
Histological Description: The tumor in the node consists of variably sized nests of tumor with central necrosis and focal cribriform formation. Cytologically, the tumors cells are relatively uniform with out marked variation in size and shape. Chromatin is delicate with prominent nucleoli. Mitotic figures are frequent. The cytoplasm is lightly eosinophilic.
Discussion: The morphology is typical of high grade prostate cancer. Prostate cancer is relatively unique, in that even for very high grade tumors, there is typically relatively little pleomorphism. Rarely, patients can present with metastatic disease in distant lymph nodes, such as the left supraclavicular neck nodes where the thoracic duct terminates. In cases presenting with left supraclavicular lymph node metastases, serum PSA values and digital rectal exam may be normal and there may not be bone metastases, such that ultimately the pathologist must establish the diagnosis. The most sensitive and specific marker for prostate is NKX3.1.
Cho KR, Epstein JI. Metastatic prostatic carcinoma to supradiaphragmatic lymph nodes. A clinicopathologic and immunohistochemical study. Am J Surg Pathol. 1987;11(6):457-63.
Incorrect
Answer: Metastatic Prostate Cancer
Histological Description: The tumor in the node consists of variably sized nests of tumor with central necrosis and focal cribriform formation. Cytologically, the tumors cells are relatively uniform with out marked variation in size and shape. Chromatin is delicate with prominent nucleoli. Mitotic figures are frequent. The cytoplasm is lightly eosinophilic.
Discussion: The morphology is typical of high grade prostate cancer. Prostate cancer is relatively unique, in that even for very high grade tumors, there is typically relatively little pleomorphism. Rarely, patients can present with metastatic disease in distant lymph nodes, such as the left supraclavicular neck nodes where the thoracic duct terminates. In cases presenting with left supraclavicular lymph node metastases, serum PSA values and digital rectal exam may be normal and there may not be bone metastases, such that ultimately the pathologist must establish the diagnosis. The most sensitive and specific marker for prostate is NKX3.1.
Cho KR, Epstein JI. Metastatic prostatic carcinoma to supradiaphragmatic lymph nodes. A clinicopathologic and immunohistochemical study. Am J Surg Pathol. 1987;11(6):457-63.
