adenocarcinoma resolved with hormonal therapy ...

Malignant pleural effusion from prostatic adenocarcinoma resolved with hormonal therapy. M Carrascosa, J L Perez-Castrillon, M A Mendez, L Cillero and R Valle Chest 1994;105;1577-1578 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/105/5/1577

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Malignant Prostatic Resolved Miguel

Pleural Effusion From Adenocarcinoma With Hormonal Therapy*

Carrascosa,

Maria

Angeles

Reina

Valle,

M.D.

Jose

;

Mendez,

Luis

M.D.;

Perez-Castrillon,

Lourdes

M.D.;

Cillero,

M.D.;

and

M.D.

A 73-year-old man presented with dyspnea, right-sided pleural effusion, and bilateral pulmonary infiltrates. The pleural fluid revealed adenocarcinoma cells that stained positively for prostatic specific antigen (PSA), which this

confirmed

uncommon

metastatic

involvement

from

prostate cancer. The dyspnea effusion, and infiltrates disappeared after therapy with flutamide and leuprolide was started. This report demonstrates both the usefulness of immunocytochemical staining for PSA in ascertaining the origin of malignant pleural effusion in men and the effectiveness of the aforementioned endocrine therapy in such setting. (Chest 1994; 105:1577-78) 3. Posteroanterior prior to symptoms

FIGURE

months development

of

chest radiograph is normal.

mediastinal

the

prior

to

normal

chest

radiograph

knowledge, veloping

of symptoms, and

was

Three

the

patient

had

asymptomatic.

is no documented

case

such

a relatively

time

rapid

I F

PSAprostatic

there in

three

lymphadenopathy.

onset

months

obtained

To

of sarcoidosis

rostatic

a

a case

de-

confirmed

antigen

adenocarcinoma

newly

our

frame.

specific

has

diagnosed

of

metastatic

antigen

(PSA)

and

leuprolide.

the

in male

patients.’

pleural

effusion

from

by a positive

cific

become

cancer

tumor

and

cell

common

We

describe

prostate

stain

successfully

most

cancer

for prostatic

treated

with

spe-

flutamide

CONCLUSION

CASE It has and sis

been

right can

previously

paratracheal cause

subsequent

case,

as in the

described

perfusion

were

defect

clinical

radiographic

abnormalities,

of

mented. disease

In

sarcoidosis

our

that

case,

literature,

this

usual

length

is not

well

the

developed

marked in

a right

the of

phia: 2

JA,

Fraser

WB

Faunce

RG.

Synopsis

Saunders,

HF,

pulmonary

artery

Hietala

of time

for

the

count,

or of

months

de-

docu-

mediastinal

time

chest.

Philadel-

Sy W.

compression

Stinnett

Smith

RH.

1977;

237:572-73

5 Damuth

Pulmonary

JL,

pulmonary

RG,

yet

variable Radiology

major 1976;

artery

Degraff

AC.

artery TE,

BowerJS, causing

Chest

1980;

AR,

Scoggins

in sarcoidosis.

WG, JAMA

Sarcoidosis,

Cho

hilar

Radiology K, Dantzker

pulmonary

adenopathy,

1973; DR.

108:585-86 Major

hypertension

pulmonary in sarcoidosis.

78:888-91 Tisi

roentgenographic 1969;

narrowing

narrowing.

stenosis EM,

Sharpe

106:770-76

tal

GM,

Moser

comparisons

KM.

Pulmonary in sarcoidosis.

and

Hg,

a PaCO2

ume

echocardiography and

which

2.20

the

stained

was L (84.3

exudate

the

pelvic

bones,

*From

the

Hg,

mm

and

Hg.

infiltrates

a small

A

both

right-sided

FEy1

was

percent).

pleu-

with

thoracic

an

and

lumbar right

percentof and

left

L (61.8

percent

predicted)

percent). the

The

residual

effusion

was

tovol-

a straw-

of an adenocarcinoma

immunocytochemical

assay, bone and

sternum,

pleural

suggestive

minimal

2.31

(74.07

percent)

The cells

positively

L (50.1

percent

L (68.6

containing

was

1.37

of 59.52 4.51

demonstrated

capacity

for PSA (immunoenzymometric mark). A technetium-99m-DPD involving

46

pulmonary and

only Vital

index

capacity

was

B lines,

breathing

1).

a Tiffeneau lung

diffuse

sedimen-

while

of

cell

calcium

of 40 mm

difference

bilateral Kerley

levels

rales

with

erythrocyte

of 56 mm

hypertrophy.

colored

artery 6 Schibel

HF,

The

physical blood

profile

a Pa02 revealed

The bilateral

a complete

gas

2

adenocarcinoma

for some

blood

al-

obstructive

prescribed.

a urinalysis.

drank

performed

outlet

biochemistry

pressure

He

prostatic

included

dyspnea

been

bladder

been

tests

and

oxygen

of predicted)

had

except

serum

interstitial,

ventricular

complaints.

disclosed

clinic

exertional

Arterial

(Fig

Doppler Protracted in sarcoidosis.

Faunce

and

ral effusion

to the outpatient

60 mm/h.

film

alveolar of the

other

had

laboratory

alveolar-arterial

chest-x-ray

640-44

GC,

was

any

no abnormalities studies,

air showed

an

study

phosphatase,

rate

referred progressive

to relieve

therapy

Routine

alkaline

room

is notable.

disclosed coagulation

tation

hospital

specific

was and

Prostatectomy

pathologic

further

wheezes.

and

He denied

in another

examination

and

cough

occasionally.

The

no

with SO,

4 Wescott

and

nonsmoker

4 months.

earlier

a diag-

119:313-14 3

beverages

be

understood

of diseases

1983;

Ramsay

past

should

REFERENCES 1 Pare

for the coholic symptoms.

In

male

of nonproductive

years

lymphade-

amount

three

our

combination

sarcoidosis The

In

presentation.

with

because

arteries

mediastinal

initial

setting,

consideration.

velopment

at

A 73-year-old

to sarcoido-

pulmonary

in the

REPORT

hilar

defects.24

and

discovered

appropriate

nostic

of perfusion

examples

massive

secondary

compression segmental

lobe

nopathy

that

adenopathy

extrinsic

with

upper

documented

marker

Dakopatts, Glostrup, Denscan revealed metastases

spine, femur.

ribs By that

on time,

the

right

side,

we received

photo-scanningAm

J

Roentgenol

Cantabria,

Servicio

de

Medicina

Interna,

Hospital

de

Laredo,

Spain.

CHEST

I 105 I 5 I MAY,


1994

1517

lung

or pleural

metastases

disseminated

recognized static

patterns

prostate

cancer

are,

sively

normal

in other

assay

monary pleural the

results

was

197

U/L

for

serum

(normal,

three

times One

and

the

to 18 U/L.

At follow-up

the

was after

chest

prostatic

acid

and

his

chest

cells gradually

repopulate

therapy

curative.4

abnormality

(Fig

2).

The

and

the

prostatic

pulmonary

patient

discloses function

acid

phosphatase

other

showed value

the

film

acetate,

marked

cancer

deaths

autopsy

has its

most

distant frequent

liver.

The has

tation

to 25

chest

x-ray

been

as-

significant

tests

show

level

is 1.7 U/L.

and

clear

films

show

lit fact.

cause

colon

cancer.2

is

to

progression-free

length

of survival

from

advanced

evidence ( ra\vfor(l

the

up

cancer,5

of disease aI

to

46

in less

fotind

oisl’

the the me-

at presen-

initial

inhibits

of

with

16.5

in

the

a communiand

a median

of hormone

with

was

suspected

all

now,

time.

and

the

Lymphangi-

of

the

chest

its resolution

we

and

progression-

until

the

and but

cancer

The

because

picture,

therapy

prostate

is 22 months

tolerated

do not

x-ray

with

have

the

histologic

diagnosis.

pleural

that immunocyin all male pa-

adenocarcinoma

combination

and

that

used

months

usefulness

patient

seriously

fectiveness

leuprolide,

with

is emphasized.

metastatic

If positive,

of

been

In summary, we would recommend tochemical staining for PSA be performed tients

a

the binding hormone

cancer,

patients

well

the

flutamide,

with

has

of

the

clinical

confirmation

an

hormonal

of

in combination

treatment,

leuprolide

6 per-

I 4 cases

the

as

such

months.7

of

carcinomatosa

film,

origin.

although than

tis

that

prostate

case,

been

therefore

hormone-releasing

survival

of our

has

and consisting

agent

metastases

survival

case,

hormone-independent

tumor

nucleus,

management

therapy

the

the

of 35.6

aforementioned

already

pulmonary 5 percent

prostate

ct

In

12

free

the prostate

present

of gonadotropins,

present

most

goal is to suppress androgens in development. However, follow-

Therapy

cell

release

catecl

the

a positive

performed.

deprivation,

of disseminated

In the

of

and bones being by the lungs and

recognized

to range

in

leading

50 years old.3 24 percent of patients

of clinically reported

percent

of cuses.

ccitt

lung

metastases,4 lymph nodes sites involved followed

incidence

tastases

third

frequency

percent in men more than At the time of presentation, have

the

after

reported

the

identifies

In the

The tumor

luteinizing

intrathoracic

become

in males,

series,

of

treatment

DISCUSSION

cancer

to the

inhibits

decreased

for PSA

antiandrogenic

analog

in

Prostatic

is not

nonsteroidal an

cancer. further

hormonal

androgens

he

remains no

initial

is considered

procedure

level

of therapy,

phosphatase later,

x-ray

film

deprivation

exclu-

in 1941 by Huggins and Hodges, anremains the mainstay of therapy for met-

astatic prostate order to inhibit

250 7.5

without

onset

diagnostic

pulright

flutamide,

begun the

x-ray

22 months

ymptomatic

with

the

a day, and leuprolide

month

dyspnea,

improvement,

improvement

diffuse a small

phosphatase;

Therapy

monthly,

medications. exertional

acid

U/L).

intramuscularly

associated denied

prostatic

S4.5

by mouth

given

film demonstrating bilateral alveolar and interstitial, and

ing

of a test

mg, given mg,

x-ray both

the

its introduction

drogen 1. Chest infiltrates, effusion.

FIGURE

produced

cells and not found Moreover,

site of malignancy.5

was

Since

frequency,

lymphadenopapleural effusion,

prostate tissues,

five

in meta-

decreasing

of prostatic stain

primary

of

mediastinal isolated

or neoplastic

marker

immunocytochemical

the

in order

with

The

involvement

and neoplastic

normal

sensitive

patients

cancer.

tumor emboli.5 antigen, a glycoprotein

specific

by

of 603

prostate

metastases, carcinomatosa,

microscopic Prostatic

series

untreated of intrathoracic

nodular pulmonary thy, lymphangitis and

in their

previously

of unknown

therapy

should

be

with

flutamide

considered

owing

and to

its

ef-

safety.

of

REFERENCES 1 Gittes

RF.

Carcinoma

of

the

prostate.

N

J Med

Engl

1991;

324:236-45 2

Silverberg

E,

Lubera

JA.

Cancer

statistics,

1989.

CA

1989;

(vol

2). In:

39:3-20 WJ,

Scott

WW.

JH,

Gittes

RF,

3 Catalona Harrison eds.

Campbell’s

of the

urology.

4th

AD,

ed.

prostate

Staney

TA,

Philadelphia:

Walsh

WB

PC,

Saunders,

1085

1979; 4

Carcinoma Perlmuter

Badalament

5 Mestitz

RA,

DragoJR.

H, Pierce

Prostatecancer.

RJ, Holmes

of disseminated

prostatic

PW.

DM

1991;37:201-68

Intrathoracic

manifestations

adenocarcinoma.

Respir

Med

1989;

83:161-66 6

Bolton

BH.

prostate: 1965;

tial

2. Chest opacities.

1578

roentgenogram

showing

mild

bilateral

intersti-

and

metastases case

from

report

carcinoma

of a long

remission.

of

the

J

Urol

94:77

7 Crawford FIGURE

Pulmonary

incidence ED,

Benson

R, Dorr

without

flutamide

Eisenberger

MA,

FA. A controlled in prostatic

McLeod

DC,

trial

of leuprolide

carcinoma.

Spaulding

N Engl

JT,

with and J Med 1989;

321:419-24

Malignant

Pleural

Effusion

from

Prostatic


Adenocarcinoma

(Carrascoa

et a!)

Malignant pleural effusion from prostatic adenocarcinoma resolved with hormonal therapy. M Carrascosa, J L Perez-Castrillon, M A Mendez, L Cillero and R Valle Chest 1994;105; 1577-1578 This information is current as of July 14, 2011 Updated Information & Services Updated Information and services can be found at: http://chestjournal.chestpubs.org/content/105/5/1577 Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.chestpubs.org/site/misc/reprints.xhtml Reprints Information about ordering reprints can be found online: http://www.chestpubs.org/site/misc/reprints.xhtml Citation Alerts Receive free e-mail alerts when new articles cite this article. To sign up, select the "Services" link to the right of the online article. Images in PowerPoint format Figures that appear in CHEST articles can be downloaded for teaching purposes in PowerPoint slide format. See any online figure for directions.
