Ectopic ACTH, prostatic oat cell carcinoma, and marked hypernatremia

Abstract

Locally recurrent, poorly differentiated carcinoma of the prostate was associated with hypokalemic alkalosis, marked hypernatremia, diabetes mellitus of recent onset,pd hyperosmolar syndrome. These findings,with mild hypertension, in the absence of clinical features of Cushing's syndrome, suggested an ectopic ACTH syndrome. Plasma ACTH and cortisol levels were markedly elevated, and failed to suppress in response to either low or high-dose dexamethazone administration. The patient's condition deteriorated rapidly. Autopsy findings included carcinoma extensively infiltrating the prostate with extension to the urinary bladder, and metastases confined to the pelvic nodes and soft tissues. The adrenal glands weighed 23 g and showed diffuse hyperplasia. Extract of the prostatic tumor was analyzed for ACTH and showed approximately 40 times normal plasma levels (or about 4,010 pg/g of tissue); ultrastructural features showed secretory granules consistent with ACTH content of the tumor cells. Such cells were positive when stained for ACTH by peroxidase-tagged immunochemical methods. The case fulfills all established criteria for relating excess corticosteroid production and nonpituitary tumors.

Case report: Subcutaneous metastasis from small cell carcinoma of the prostate

“…One theory suggests that according to immunohistochemical and electron microscopic studies SCCP arises from cells in the prostatic epithelium that have dual capacity for differentiation into adenocarcinoma and small cell carcinoma [4]. It has been suggested by some authors that SCCP is derived specifically from the argyrophil and argentaffin cells normally within the prostate [6]. Some authors have hypothesized that both tumor types arise from a pluripotent stem cell that is able to differentiate into both a mature prostatic epithelial cell and a neuroendocrine cell [7].…”

Small Cell Carcinoma of the Prostate

“…Prostatic SCC was first described by Wenk et al 15 more than 30 years ago. Since then, it has been reported to occur in 0.5-2% of men with prostate cancer, although autopsy studies of men who have died of castration-resistant prostate cancer (CRPC) have reported the presence of SCC in up to 10-20% of cases.…”

Neuroendocrine carcinomas of the prostate and urinary bladder: a diagnostic and therapeutic challenge

“…Rarely, spotty expression of cytokeratin 34βE12 may be seen in high-grade NECs of the urinary bladder. High-grade NECs of the prostate and urinary bladder may be associated with Cushing's syndrome due to the production and secretion of adrenocorticotropic hormone (ACTH), which can be identified immunocytochemically in the tumour cells [20,23,46,67].…”