Prostate Cancer Metastasis Presenting as Isolated Mediastinal Adenopathy With Tracheal Invasion

Abstract

Isolated mediastinal masses are an uncommon manifestation of prostate cancer metastasis. Here we report a unique presentation of a patient with prostate adenocarcinoma who presented with massive mediastinal adenopathy with aggressive tracheal invasion. CASE PRESENTATION:A 73 year old male with a history of prostate cancer was transferred for progressive dyspnea and radiographic airway narrowing. On physical exam the patient was in mild distress with phonation. He had course lung sounds in the upper lobes, diminished in the lower lobes, without stridor or wheezing. A computed tomography of the chest revealed a bulky right paratracheal mass that laterally invaded of the right side of the trachea. This caused approximately 50% occlusion of the tracheal lumen. The mass measured 7.6 cm AP, 7.9 cm transverse and 7.8 cm craniocaudal. CT demonstrated no parenchymal abnormalities or pulmonary nodules. Given the isolated lymphadenopathy, it was thought that this presentation was related to a separate primary lung malignancy over a metastatic focus of disease. The patient subsequently underwent debulking via rigid bronchoscopy. Pathology confirmed a diagnosis of metastatic prostatic adenocarcinoma with high-grade neuroendocrine carcinoma features.

Metastatic prostate cancer presenting as a posterior mediastinal mass: A rare presentation

“…Bone and lymph nodes are common sites among those with metastatic lesions, with pulmonary, hepatic, retroperitoneal, or abdominal metastasis very uncommon 6 . Mediastinal metastasis is exceedingly rare and can present with mediastinal adenopathy in 0.6% of the cases 7 . Only one other case of prostate cancer is reported presenting with a mediastinal mass 8 .…”

“… 6 Mediastinal metastasis is exceedingly rare and can present with mediastinal adenopathy in 0.6% of the cases. 7 Only one other case of prostate cancer is reported presenting with a mediastinal mass. 8 In the United States, significant racial differences exist in the management of prostate cancer.…”