A 73-year-old male presented at our department with a history of diabetes mellitus, ischemic heart disease, smoking until 1993, without known drug allergies.
In July 2001, after several months of rectal discomfort, a PSA value of 16.68 ng/ml was observed in routine laboratory tests.
Remitted from Primary Care to Urology, it is diagnosed by biopsy of Prostate adenocarcinoma in the right lobe, Gleason 3+3 (T1cNxMx, Stage II).
After establishing complete androgen deprivation (CAB) with Bicalutamide and Leuprorelin is prescribed in our Service, where toracoabdominal CT is requested to complete staging.
Pending the result of this test due to the delay in its realization and taking into account the patient's age and stage of the disease, the RT treatment is initiated.
A dose of 70 Gy is programmed on prostate and seminal vesicles, using 18 MV photons, 4 fields in boxing technique and 2 Gy/day, 5 days per week.
CT (11/10/01) was performed before the end of the treatment. A solid mediastinal mass of 3 cm was observed, the left paraesophageal mass was superior to an adenopathic mass, and it could not differentiate between an adenopathic neoplasm and a
A right renal solid mass, approximately 7 cm in diameter, with central necrosis, suggestive of hypernephroma is also visualized.
No vascular alterations, retroperitoneal lymphadenopathy or significant pelvic alterations were observed.
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After the result of the CT, it was decided to continue the irradiation on the prostate, ending the treatment on November 26, 01.
However, since the renal mass did not raise diagnostic doubts, it was decided to approach the thoracic lesion.
A mediastinoscopy with biopsy was performed on November 15, 01, with a histological result of clear cell carcinoma, compatible with metastasis of the Renal Carma.
According to Ondio Medical and Urology, Nephrectomy (NF) is performed 21/01, with definitive histological result of renal cell carcinoma II-III, M/121, perirenal adipose tissue).
Once there is no possibility of surgery for mediastinal metastases, a CT scan (30/01) is performed, in which the presence of the pulmonary mass is observed, with an approximate size x 3 x 4 cm proximal clconesophageal, with vascular structures located nearby.
Abdominally, the right NF is visualized without signs of recurrence or tumor remnants.
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The 27 location is determined by exploratory laparotomy which found a 5 cm mediastinal tumor that obstructs the pulmonary parenchyma and the superior aspect of the aortic arch at the level of a lateral plate which is considered irresectable.
Biopsy was taken and the diagnosis was confirmed.
The possibility of radiotherapy for mediastinal injury, followed or not by immunotherapy is raised, but the patient does not accept this possibility and considering his good general condition, an expectant attitude is adopted.
The patient continues with CR-BSI and symptomatic treatment.
In June 2002 treatment with Megestrol Acetide for "software" secondary to CR-BSI was initiated one month after discontinuation of CR-BSI.
In September 2002 a bone scintigraphy was performed, which showed no pathological tracer deposits, as well as a PSA determination (0.10 ng/ml) and a new CT.
The CT scan (12/09) showed a mass in the posterior mediastinum, above the aortic arch, of 6 x 4 cm in the right lung, suggestive of left subclavian artery, nodular images and adjacent lung, as well as metastasis to the left spine.
In the abdomen multiple nodular images are visualized in the right renal fossa suggesting recurrence, with probable ipsilateral psoas muscle incontinents.
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Therefore, and as a conclusion after the last CT (9 months after NF), the patient has a clear progression of his disease, with new metastases and local recurrence.
In October 2002 she was admitted due to clinical suspicion of pulmonary thromboembolism, without scintigraphic confirmation.
After discharge she is seen on an outpatient basis on several occasions, showing a progressive improvement in her general condition.
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In September 2003, 21 months after FN and the patient was asymptomatic, a thoracic and abdominal CT was performed (16/09/03), which showed only several axillary lymphadenopathies less than 1 cm and other complete radiological lesions - complete NF-.
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Ongoing months after NF, two subsequent CT scans show persistent response and the patient remains asymptomatic.
Prostate cancer continues to respond completely, with PSA nadir of 0.10 ng/ml and no alterations in bone scintigraphy.
