A 54-year-old male patient with no relevant personal history.
He came to the emergency department of our hospital in September 2005 for right frontoparietal headache and diplopia of lateral gaze of evolution as well as right pleural edema for a week.
The patient was initially assessed by the Ophthalmology Department with the objective of presenting moderate exophthalmos in right eye, inflammation, hyperemia and swelling and mild upper and lower right diplopia, limitation of gaze in all positions.
There was no change in visual acuity.
The intraocular pressure (IOP) of the right eye was 20 mmHg, the IOP of the left eye was 10 mmHg.
Examination of the eye fundus was normal.
An orbital CT was requested, showing an increase in the size of the sphenoid bone with a permeative pattern and hyperostosis of the orbital face with a soft tissue mass that bulged the lateral rectus muscle.
The occupation of cells was also produced.
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The patient was admitted to the Neurosurgery Service requesting cranial MRI which was reported as a possible hyperostotic meningioma in right periorbital plaque without ruling out fibrophenoid lesions.
Surgical biopsy of these lesions was programmed.
The anatomopathological result of the biopsy of connective tissue was similar to what was previously observed and isolated trabeculae with bones and cords of epithelial cells with broad cytoplasm which formed focally glandular histoplasmosis.
These findings were consulted with the Urology Department.
A directed anamnesis revealed alterations in the voiding in recent months (polakiuria and nocturia) and hemopermia.
Establishment
Rectal tract: prostate volume II/IV, with a stony consistency in both lobes, fixed, suspect of prostate cancer.
Complementary tests
PSA: 389 ng/ml
Transrectal prostate biopsy: adenocarcinoma pro Gleason 4+4=8 that affects both lobes extensively.
Bone scintigraphy with Tc99m: the images showed multiple areas of hypercaptation that affect the right internal zygomatic region right internal, both left and middle orbital ischial, dorsolumbar femoral region.
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Diagnosis
Prostate adenocarcinoma Gleason 4+4=8 with multiple bone metastases.
Treatment
Treatment was established with complete hormonal blockade (Bicalutamide 50 mg/24h and Goserelin 10.8 mg/12 weeks) and bisphosphonates (Zoledronic acid 4 mg iv /4 weeks).
Ev
After the introduction of androgen deprivation, there was a progressive improvement in ocular symptoms.
During the first 7 months of follow-up, the patient remained asymptomatic.
After 8 months, the patient was admitted to the Urology Department with hematuria, which did not improve with continuous bladder lavage, required the performance of bladder TUR, observing a large neoformative process bladder floor.
Pathological anatomy of the resection fragments: foci of adenocarcinoma pros with involutive changes secondary to hormonal treatment.
Nine months after the initial diagnosis, the patient was admitted again to our service for obstructive voiding syndrome, decreased diuresis, impaired renal function, and dyspnea.
The patient was managed conservatively, showing pleural effusion with compression, multiple mediastinal lymph nodes, multiple pulmonary lymph nodes, multiple blastic dilatation of the left kidney and multiple blastic metastases.
Right pleurocentesis was performed (the pleural fluid cytology was positive for malignant tumor cells).
Percutaneous nephrostomy placement is discouraged.
The patient is controlled by the Palliative Care Unit.
He died 10 months after the initial diagnosis.
