FROM THE PROSTATE TO THE LUNGS WITHOUT ANY BONY STOPOVERS

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: metastases have been reported in over 40 percent of men with prostate cancer (1). One third to half patients metastasis at time presentation bone involvement 90 the cases. Prostate that metastasizes lungs without any is a rare occurrence (2). CASE PRESENTATION: A 75-year-old male veteran presented complaints hemoptysis, weight loss, and fatigue for approximately three months. In regards malignancy associated risk factors, he was former smoker had previous exposure agent orange. Upon presentation, history cancer, diagnosed 7 years prior treated brachytherapy leuprolide injections setting biochemical recurrence. Due concern recurrence based on his current clinical underwent scan DEXA scan, both which did not reveal lesions suggest metastatic disease. Additionally, CT abdomen/pelvis revealed no evidence periprostatic lesions, lymphadenopathy, or osteoblastic/osteolytic lesions. thorax showed multiple bilateral pulmonary as follows: right major minor fissure, posterior medial pleural cavity largest cluster left lower lobe/major fissure measuring 3.6 x 2.7 cm. No definite lymphadenopathy osseous were identified. Patient then PET/CT confirmed FDG-avid masses borderline prominent mediastinal, hilar, supraclavicular lymphadenopathy. At this time, high suspicion new primary rather than metastasis, patient CT-guided core biopsy followed by two weeks later. The lung demonstrated tumour cells strongly positive TTF-1, negative p40 consistent adenocarcinoma lung. diagnosis assumed until carcinoma TTF-1 NKX3.1, suggestive malignant originating prostate. DISCUSSION: Although often expressed lung, it very specific can be adenocarcinomas from various anatomic sites. Meanwhile, NKX3.1 sensitive but prostatic carcinomas (3). Isolated concurrent lymph node uncommon only few published literatures. Diagnosis challenging, crucial ensuring effective treatment patient. CONCLUSIONS: This case emphasizes importance considering differential presenting nodules, even absence bony metastasis. It also demonstrates immunohistochemistry identifying site origin REFERENCE #1: Saitoh H, Hida M Shimbo T (1984) Metastatic Patterns Prostatic Correlation Between Sites Number Organs Involved 54 3078–3084 PMID: 6498785 #2: Kume Takai K, Kameyama S, Kawabe K. (1999) Multiple Pulmonary Metastasis Carcinoma Little Lymph Node Metastasis. Urologia Internationalis (62) 44-47. https://doi.org/10.1159/00003035 #3: Conner JR, Hornick JL. Unknown Primary: Diagnostic Approach Using Immunohistochemistry. Adv Anat Pathol. 2015 May;22(3):149-67. doi: 10.1097/PAP.0000000000000069. 25844674 DISCLOSURES: relevant relationships Man Dai, source=Web Response Jessica Gosse, Patricia Morissette, Steven Yi,