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  • Author
    Regina Liu
  • Co-author

    Regina Liu, BA, Joan Leavens, MD, Chandra Smart, MD

  • Title

    A case of cutaneous metastatic prostate carcinoma as initial evidence of neuroendocrine differentiation

  • Abstract

    Prostate carcinoma is one of the leading causes of death in men. Neuroendocrine (NE) differentiation is a well-recognized phenotypic change in prostate carcinoma where tumor cells transdifferentiate into NE-like cells, which lack expression of androgen receptor and prostate specific antigen. Distant cutaneous metastasis of prostate carcinoma is an extremely rare phenomenon, estimated in less than 0.1% of patients. While NE differentiation is common in primary prostate carcinomas, it is rare in metastatic disease. NE differentiation in prostate carcinoma is important to recognize due to its implications on prognosis and management. Patients with metastatic prostate carcinoma with NE differentiation have a poor response to standard androgen deprivation therapy and may have improved clinical outcomes with alternative treatment regimens. We present a rare case of cutaneous metastatic prostate carcinoma with NE differentiation presenting as a nodule on the upper chest of a patient with advanced metastatic prostate carcinoma. While the initial prostate biopsy was negative for the NE markers synaptophysin and chromogranin A, biopsy of the metastatic chest nodule showed positive staining for synaptophysin and chromogranin A. There are only three previously reported cases of cutaneous metastatic prostate carcinoma demonstrating NE differentiation and one case in which the cutaneous metastasis represented the first evidence of NE differentiation, as in this case. The case presented here underscores the importance of having a low threshold to sample new cutaneous lesions in patients with a known history of prostate carcinoma and to evaluate for NE differentiation through immunohistochemical markers.

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