Jul 14, 2011 - in order of decreasing frequency, nodular pulmonary metastases, mediastinal lymphadenopa- thy, lymphangitis carcinomatosa, isolated pleural.
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
Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright1994by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692
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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,
Downloaded from chestjournal.chestpubs.org by guest on July 14, 2011 © 1994 American College of Chest Physicians
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
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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.
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