Synchronous Metastasis of Prostate Adenocarcinoma to the Stomach and Colon: A Case Report
A 71-year-old African American man with a medical history significant for hypertension, prostate cancer treated with surgery and radiation therapy over 10 years ago, diabetes mellitus, and a bilateral knee arthroplasty for severe degenerative arthritis was admitted with complaints of weakness and dizziness. He stated that over the past few weeks, he experienced poor activity tolerance. He had to use tables and walls for support while walking. He denied any symptoms of nausea, vomiting, abdominal pain, melena, changes in bowel habit, bright red blood per rectum, or hematuria. Physical examination revealed a thinly built male in no acute distress with pale conjunctiva, otherwise essentially unremarkable. Vitals signs showed a temperature of 97.8, pulse 86, blood pressure 147/88 mm/Hg, and respiratory rate 16. Laboratory data revealed hemoglobin of 6.1gm/dl, hematocrit of 18.3%, platelet count of 196,000/μl, white blood cell (WBC) count of 4,000/μl, mean corpuscular volume of 80 μ3, red cell distribution width of 21.6%, reticulocyte count of 2.1%, blood urea nitrogen (BUN) of 12 mg/dl, creatinine of 0.75 mg/dl, prothrombin time of 15 sec, international normalized ratio of 1.2, activated partial thromboplastin time activated partial thromboplastin time (APTT) of 38.7 sec, and prostate-specific antigen (PSA) of >150 ng/ml. Iron studies revealed serum iron level of 68 μg/dl, ferritin of 1,500 ng/dl, iron binding capacity of 157 μg/dl, and an iron saturation of 43%. The patient's previous laboratory data revealed hemoglobin of 8.0 gm/dl and hematocrit of 24.6%. The patient was transfused three units of packed red blood cells; furthermore, gastroenterology was consulted to rule out gastrointestinal loss as the etiology of the patient's anemia. The patient underwent endoscopic evaluation with esophagogastroduodenoscopy (EGD) and colonoscopy. EGD [] revealed a 5-mm nodule in the fundus and a 5-mm clean-based ulcer in the body of the stomach; multiple erosions were found in the antrum. Biopsies were taken from the fundus nodule, gastric body ulcer, and antrum and sent for pathology. Colonoscopy [] revealed diminutive sessile polyps in the cecum, sigmoid colon, and rectum, in addition to large internal hemorrhoids. All polyps were removed by cold forceps polypectomy. Biopsy results from the antrum and body ulcer showed minimal inflammatory cell infiltration, and the stains for Helicobacter pylori were negative. The pathology results from the cecal polyp and rectal polyp revealed hyperplastic polyps. However, the pathology studies of the sigmoid polyp and fundus nodule [Figure and ] were consistent with adenocarcinoma, and special immunohistochemical staining [Figure and ] confirmed that it was consistent with prostatic origin. The patient was subsequently started on antiandrogen (bicalutamide 50 mg/day p.o.) and leuprolide acetate [luteinizing hormone-releasing hormone (LHRH) agonist]. The PSA level decreased to normal levels within 4 months. The patient has remained hemodynamically and clinically stable for 6 months since the diagnosis of synchronous metastasis of prostate cancer to the stomach and colon.