title: Metastatic prostate cancer masquerading clinically and radiologically as a primary caecal carcinoma.
abstract: BACKGROUND
  Prostatic carcinoma is the second most common cause of cancer-related deaths in males in the West. Approximately 20% of patients present with metastatic disease. We describe the case of a patient with metastatic prostate cancer to the bowel presenting clinically and radiologically as a primary caecal cancer.
  
  
  METHODS
  A 72 year-old man presented with abdominal discomfort and a clinically palpable caecal mass and a firm nodule on his thigh, the latter behaving clinically and radiologically as a lipoma. Computed tomographic (CT) scan showed a luminally protuberant caecal mass with regional nodal involvement. The patient was being treated (Zoladex) for prostatic cancer diagnosed 6 years previously and was known to have bony metastases. On admission his PSA was 245.4 nmol/ml. The patient underwent a right hemicolectomy. Histology showed a poorly differentiated adenocarcinoma which was PSA positive, confirming metastatic prostatic adenocarcinoma to the caecum. The patient underwent adjuvant chemotherapy and is free from recurrence a year later.
  
  
  CONCLUSIONS
  Metastasis of prostatic carcinoma to the bowel is a very rare occurrence and presents a challenging diagnosis. The diagnosis is supported by immunohistochemistry for PSA. The treatment for metastatic prostate cancer is mainly palliative.
authors.affiliation: Department of Histopathology, Royal Cornwall Hospital, Truro, TR1 3LJ, UK. muhammad.kabeer@rcht.cornwall.nhs.uk
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Kabeer
authors.forename: Edward
authors.initials: E
authors.lastname: Lloyd-Davies
authors.forename: Giles
authors.initials: G
authors.lastname: Maskell
authors.forename: Rolf
authors.initials: R
authors.lastname: Hohle
authors.forename: Joseph
authors.initials: J
authors.lastname: Mathew
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D000368:Aged; D001707:Biopsy, Needle; D002430:Cecal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000379:methods; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D012007:Rectum; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome