Small-cell carcinoma of the prostate: metastases to the brain as shown by CT and MR with pathologic correlation.

A 63-year-old man with a history of hypertension and non-insulindependent diabetes mellitus had had fever, night sweats, and vertigo for 2 months. Digital rectal examination revealed a firm prostate containing a small , hard, centrally located nodule. No other abnormalities were detected on physical examination. Laboratory studies showed an elevated erythrocyte sedimentation rate, increased levels of C-reactive protein and lactic dehydrogenase, and decreased levels of serum albumin. Further workup included a gallium scan, flexible sigmoidoscopy, abdominal CT and MR imaging, and CT and MR of the liver. None of these examinations showed any pathologic changes. A mTc-labeled methylene diphosphonate bone scan showed abnormal uptake of the nucleotide in several areas, including the calvaria; multiple levels of the cervical , thoracic, and lumbar spine; pelvis; ribs; left femoral neck; midshaft of the right femur; sternum; and right shoulder, all consistent with diffuse osseous metastatic disease. Bone marrow obtained from the left superior iliac crest contained tumor cells of metastatic adenocarcinoma, and the histologic findings were consistent with those of a primary tumor of the prostate. Tumor cells in the bone marrow were positive for prostatespecific antigen by the immunoperoxidase technique. Follow-up needle biopsy of the prostate showed class 5 cells , and follow-up laboratory blood analysis showed markedly increased serum levels