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Year : 2017  |  Volume : 24  |  Issue : 1  |  Page : 90-92

Muscle metastasis from prostate cancer

Department of Medical Imaging, University Hospital Center of Antananarivo, Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar

Date of Web Publication11-Jan-2017

Correspondence Address:
Andrianah Emmylou Gabrielle Prisca
Department of Medical Imaging, University Hospital Center of Antananarivo, Joseph Ravoahangy Andrianavalona, BP: 4150 Antananarivo 101
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1115-3474.192759

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We report an exceptional case of prostate cancer metastasis sites discovered on ultrasound, of the abdominal muscle, subcutaneous and liver.

Keywords: Atypical metastases; liver; muscle; prostate; ultrasound

How to cite this article:
Prisca AE, Hasina RN, Adrienne RK, Ahmad A. Muscle metastasis from prostate cancer. West Afr J Radiol 2017;24:90-2

How to cite this URL:
Prisca AE, Hasina RN, Adrienne RK, Ahmad A. Muscle metastasis from prostate cancer. West Afr J Radiol [serial online] 2017 [cited 2022 Aug 12];24:90-2. Available from: https://www.wajradiology.org/text.asp?2017/24/1/90/192759

  Introduction Top

The secondary locations in the abdominal muscles, subcutaneous, and liver are considered exceptional and atypical extraprostatic extensions, [1] even the postoperative complications of these cancers. [2] We report a case of a 64-year-old man who developed nodular metastases in muscles, subcutaneous, and liver after radical prostatectomy by laparotomy for prostatic adenocarcinoma, discovered by abdominal ultrasound.

The interest of this publication is to report this rare case and to show the place of ultrasonography in the diagnosis and the monitoring within the framework of a cancer extension assessment.

  Case Report Top

A 64-year-old man was referred to medical imaging and radio diagnosis for abdomino-pelvic ultrasound because of an abdominal, colicky pain evolving for 2 months with neither transit disorder nor fever.

In his personal surgical histories, he underwent a radical prostatectomy by laparotomy 6 months ago, the tissue sample pathologic result was adenocarcinoma of the prostate, for which he received no adjuvant treatment but surgery.

On physical examination at admission, the patient maintained a good condition. The abdomen was flexible, and we could feel well-limited, fixed, painless nodules on the laparotomy and drainage scars in the region of the right iliac pit. The digital rectal examination gave a shielding feeling of the rectal area, with difficulty palpating the prostatic area. Bilateral inguinal lymph node chains presented lymphadenopathies.

Abdomino-pelvic ultrasonography helped objectify an ill-defined, heterogeneous, hypoechoic mass predominant in the prostate tissue [Figure 1], probably related to a local recurrence; a bladder infiltration resulting in an irregular thickening of the wall, highly vascularized, associated with a mass suspended on its front, heterogeneous, and hyperechoic, with central vascularization in Doppler sonography. There was no obstacle syndrome of the upstream urinary tract. We found on ultrasound many lymphadenopathies locations; on the ileo-odturator chains, bilateral near kidneys and liver hilum. Also, on the segment VII of the liver parenchyma [Figure 2] seats a juxta-centimetric, hyperechoic nodule. There was no ascites. On the laparotomy and drainage scar, on the right iliac fossa we have observed two subcutaneous nodules, more and less limited, centimetric, heterogeneous, hyperechoic and a big mass, enough limited, had an identical echostructure, developed on the muscle rectus right [Figure 3], presented a central vascular signal in the Doppler sonography associated with a disorganization of muscular fibres.
Figure 1: Tissue mass suspended from the anterior bladder wall, vascularized with Doppler color, associated with a thickening of the bladder wall in keeping with infiltration

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Figure 2: Hyperechoic heterogeneous nodule, oval and well marginated, located in segment VII of the liver

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Figure 3: Heterogeneous hypoechoic, poorly limited mass within the Rectus abdominis with surrounding fiber disorganization

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The prostate-specific antigen (PSA) test could not be carried out due to the lack of means of the patient. However, 3 weeks later, after his ultrasound exam, the patient came back to our service and made the PSA test, wich was increased. In fact the fits result was 1123 ng/L and the second result already increase and was 1800ng/L after 3 months.

The biopsy of the nodule on the right rectus was made with an ultrasound guidance. The anatomopathology examination with an immunohistochemical study revealed a nodal metastasis of an adenocarcinoma of the prostate. The patient benefited six cycles of chemotherapy with an association of estramustine and vinblastine.

  Discussion Top

In our case, the diagnosis of local recurrence is performed by ultrasound as it has observed the presence of a heterogeneous mass contained within the prostate, associated with an increased PSA test. Rouvière presented a biological definition of local recurrence after treatment [3] as a rise in PSA rate; however, the imaging such as ultrasound, Doppler sonography, and magnetic resonance imaging can locate recurrence and suggest biopsy. [3] It is a major postoperative complication, and ultrasound is ideal for visualizing the operative area. [4] A high incidence of the local recurrence was noticed in 20-40% of the patients according to this series. These later distinguish two types of recurrences: biological and clinical. [5]

Our case reports ileo-obturator lympadenopathies until pararenal and hepatic hilum chains. Ileo-obturator is the first area of prostate cancer metastasis. [1],[4]

Our case shows a parietal metastasis developed on the right rectus abdomen muscle and in the subcutaneous areas on the scars of laparotomy and drainage, and the biopsy by ultrasonography confirmed the metastasis in this anatomopathology study. Döbröne [6] was the first to describe an abdominal wall metastasis of prostate cancer. Larousse reported a case of a 52-year-old man who had an orifice metastasis after radical prostatectomy by laparoscopy; abdominal computed tomography scan diagnosed an abdominal intramuscular mass. [2] In his review, Mueller established an incidence of 0.36% of the subcutaneous metastases. [7] The mechanisms proposed by the authors of these metastases are related to an altered general condition of patients, [2] a dissemination by contamination of the instruments during interventions on colon, gynecological, gallbladder, and pancreatic cancers. [2],[8],[9],[10] Hepatic metastases are rare and revealed by portal hypertension and fulminant hepatic failure. [11] Long and Husband in their study described that three patients out of 508 developed a hepatic metastasis, as a 3 cm mass seen with the abdominal computed tomography. [6]

Metastasis on the urinary tract is rare, [1] and only fifty cases were published according to Yonneauetal, [4] like Jung et al., which is revealed by upstream obstacle syndrome such as hydronephrosis. [5] In our case, there is no dilatation of the excretory cavity of the urinary tract, but there is an infiltration of the bladder wall and an anteriorly suspended mass.

The significant recurrence of these parietal masses and intra-abdomino-pelvic lymphadenopathies observed after chemotherapy ultrasound monitoring affirms the diagnosis. In Larousse's case, the computed tomography made it possible to diagnose a secondary intramuscular location of the prostatic mucinous adenocarcinoma. [2]

  Conclusion Top

Muscle, subcutaneous, and liver metastasis are atypical secondary locations of prostatic adenocarcinoma. Moreover, they are rare.

The dissemination by instruments would be the mechanism met, like in other cancers.

Imaging ultrasound may help in the diagnosis of topographic of recurrences and metastases of prostatic adenocarcinoma and can be completed by other imaging techniques.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Lebret T, Méjean A. Rare locations of metastases from prostate cancer. Progress in Urology 2008;Suppl. 7:S357-S64. [Elsevier Masson].  Back to cited text no. 1
Viville C. Local recurrence after radical prostatectomy for prostatic cancer. Ann Urol (Paris) 2000;34:53-7.  Back to cited text no. 2
Bruneton JN, Stines J, Padonavi B, Drouillard J, Roy C. Imagerie et surveillance post-thérapeutique en oncologie. Elsevier: Masson; 2000. p. 353-64.  Back to cited text no. 3
Teh BS, Chou CC, Schwartz MR, Mai WY, Carpenter LS, Butler EB. Perineal prostatic cancer seeding following radioactive seed brachytherapy. J Urol 2001;166:212.  Back to cited text no. 4
Long MA, Husband JE. Features of unusual metastases from prostate cancer. Br J Radiol 1999;72:933-41.  Back to cited text no. 5
Boyiadzis M, Nam M, Dahut W. Fulminant hepatic failure secondary to metastatic prostate cancer. Urol Int 2005;74:185-7.  Back to cited text no. 6
Yonneau L, Lebret T, Hervé JM, Barré P, Lugagne PM, Botto H. Isolated ureteral metastasis of prostatic adenocarcinoma. Apropos of a case. Prog Urol 1999;9:118-21.  Back to cited text no. 7
Jung JY, Kim HK, Roh YT, Choi DY, Yoo TK, Kim EK. Long-standing ureteral metastasis secondary to adenocarcinoma of the prostate after bilateral orchiectomy. J Urol 2000;164:1298-9.  Back to cited text no. 8
Huang E, Teh BS, Mody DR, Carpenter LS, Butler EB. Prostate adenocarcinoma presenting with inguinal lymphadenopathy. Urology 2003;61:463.  Back to cited text no. 9
Liu L, Devine P, Einhorn E, Kao GD. Incidental finding of an isolated prostate cancer metastasis in an inguinal hernial sac. J Urol 2000;164:457-8.  Back to cited text no. 10
Szentgyörgyi E. Perineal prostatic cancer seeding following Urocut needle biopsy. Int Urol Nephrol 1996;28:87-90.  Back to cited text no. 11


  [Figure 1], [Figure 2], [Figure 3]


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