What can hide an enlarged lymph node of a patient with prostatic adenocarcinoma?

Tanja Lakić; Milena Šunjević; Aleksandra Ilić; Jelena Ilić Sabo; Radosav Radosavkić

doi:10.2298/VSP220416087L

Tanja Lakić University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia
Milena Šunjević University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia
Aleksandra Ilić University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia
Jelena Ilić Sabo University Clinical Center of Vojvodina, Center for Pathology and Histology, Novi Sad, Serbia
Radosav Radosavkić University of Novi Sad, Faculty of Medicine, Department of Forensic Medicine, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP220416087L

Keywords: adenocarcinoma, comorbidity, diagnosis, immunohistochemistry, lymphoma, mantle-cell, prostatic neoplasms

Abstract

Introduction. Adenocarcinoma is the most common prostatic malignancy, where clinical management, the Gleason score, and recent updates in prostate cancer staging play critical roles. Mantle cell lymphoma (MCL) originates from the malignant transformation of B lymphocyte in the outer edge of the lymph node follicle, with pathognomonic overexpression of cyclin D1. We present a rare case of two simultaneous neoplasms occurring in the same patient. Case report. During the hospital preoperative examinations in a 68-year-old patient planned for radical prostatectomy, using multislice computed tomography, a tumor mass confined to the prostate, but also excessive lymph node enlargement, was revealed. Tissue specimens were analyzed after the hematoxylin and eosin staining was performed, as well as an immunohistochemical (IH) biomarker panel. Having performed a thorough histological examination, a diagnosis of prostatic adenocarcinoma was made, with a Gleason score 3 + 4 = 7 and Grade Group 2 of the International Society of Urological Pathology (ISUP). Microscopic analysis of lymph node involvement showed unexpected, diffuse proliferation of small lymphoid cells with irregular nuclei, wide mantle zone, and hyalinized blood vessels. After using IH staining for specific markers, another diagnosis was set, and it was non-Hodgkin MCL. Conclusion. A prostatic adenocarcinoma can rarely coexist with an undiagnosed lymphoproliferative disease, such as non-Hodgkin MCL in our case.

References

1. Sehn JK. Prostate Cancer Pathology: Recent Updates and Controversies. Mo Med 2018; 115(2): 151–5.

2. Vyas M, Menon S, Desai SB. Collision tumor of kidney: A case of renal cell carcinoma with metastases of prostatic adenocarcinoma. Indian J Med Paediatr Oncol 2013; 34(1): 21–3.

3. Macías-García L, De la Hoz-Herazo H, Robles-Frías A, Pareja-Megía MJ, López-Garrido J, López JI. Collision tumour involving a rectal gastrointestinal stromal tumour with invasion of the prostate and a prostatic adenocarcinoma. Diagn Pathol 2012; 7: 150.

4. Protocol for the Examination of Radical Prostatectomy Specimens From Patients With Carcinoma of the Prostate Gland. Version: Prostate, Resection 4.2.0.1. Northfield, Illinois: College Of American Pathologists (CAP); 2021.

5. Rajput AB, Burns B, Gerridzen R, van der Jagt R. Coexisting mantle cell lymphoma and prostate adenocarcinoma. Case Rep Med 2014; 2014: 247286.

6. Veloza L, Ribera-Cortada I, Campo E. Mantle cell lymphoma pathology update in the 2016 WHO classification. Ann Lymph 2019; 3(3): 1‒17.

7. Li S, Xu J, You MJ. The pathologic diagnosis of mantle cell lymphoma. Histol Histopathol 2021; 36(10): 1037‒51.

8. Jain P, Wang M. Mantle cell lymphoma: 2019 update on the diagnosis, pathogenesis, prognostication, and management. Am J Hematol 2019; 94(6): 710–25.

9. Maddocks K. Update on mantle cell lymphoma. Blood 2018; 132(16): 1647–56.

10. Terris MK, Hausdorff J, Freiha FS. Hematolymphoid malignancies diagnosed at the time of radical prostatectomy. J Urol 1997; 158(4): 1457‒9.

11. Chu PG, Huang Q, Weiss LM. Incidental and concurrent malignant lymphomas discovered at the time of prostatectomy and prostate biopsy: a study of 29 cases. Am J Surg Pathol 2005; 29(5): 693‒9.

12. Petković I, Stojnev S, Krstić M, Pejčić I, Vrbić S. Synchronous mantle cell lymphoma and prostate adenocarcinoma-is it just a coincidence? Vojnosanit Pregl 2016; 73(11): 1072‒5.

13. Braham E, Zarrouk M, Mlika M, Kilani T, El Mezni F. Synchronous mantle cell lymph node lymphoma and pulmonary adenocarcinoma: a case report with literature review. Clin Respir J 2017; 11(4): 430–2.

14. Galani KS, Gadage VS, Mahesh D, Menon S, Gujral S. Synchronous presentation of mantle cell lymphoma and plasma cell dyscrasia: A case report. J Case Rep Images Pathol 2016; 2: 20–4.

15. Krause JR, Sohn A. Coexisting sarcoidosis and occult mantle cell lymphoma. Proc (Bayl Univ Med Cent) 2020; 33(4): 651‒2.

16. Szumera-Ciećkiewicz A, Bikowska-Opalac B, Prochorec-Sobieszek M. "Double trouble" - synchronous mantle cell lymphoma and metastatic squamous cell carcinoma in an inguinal lymph node. Pol J Pathol 2017; 68(3): 270–4.

17. Nakatsuka S, Nagamoto T, Nagano T, Goto T, Hashimoto K. Classical Type and Blastoid Variant Mantle Cell Lymphoma in The Same Lymph node: Histology and Cytological Findings from a Touch Imprint Specimen. Diagn Cytopathol 2017; 45(4): 364-70.

18. Tlili G, Ammar H, Majdoub W, Dziri S, Farhat W, Acacha E, et al. Incidental chronic lymphocytic leukemia diagnosed following radical prostatectomy for prostate cancer: A case report. Ann Med Surg (Lond) 2021; 68: 102516.

19. Dhiantravan N, Hovey E, Bosco A, Wegner EA. Concomitant prostate carcinoma and follicular lymphoma: "flip-flop" appearances on PSMA and FDG PET/CT scans. Clin Nucl Med 2019; 44: 797–8.

20. He H, Cheng L, Weiss LM, Chu PG. Clinical outcome of incidental pelvic node malignant B-cell lymphomas discovered at the time of radical prostatectomy. Leuk Lymphoma 2007; 48(10): 1976‒80.

21. Tvrdíková E, Křen L, Kubolková AS, Pacík D. Mantle cell lymphoma diagnosed from radical prostatectomy for prostate adenocarcinoma: a case report. Cesk Patol 2019; 55(4): 231‒4.