case_images: PMC8580598_01
case_images: Left lateral neck mass of the patient measuring approximately 7 x 7.5 cm in size before initiation of treatment.
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case_images: Weight loss, occasional hypogastric pain, persistent constipation and continuous enlargement of the neck mass to approximately 7 x 7.5 cm (Figure 1) prompted the patient to seek consult at our institution.
case_images: Representative axial cut images of the abdominopelvic CT scan with oral, rectal and intravenous contrast. (a):. The prostate gland is enlarged and converted to a heterogenous mass 6.8 x 5.2 x 5.4 cm in size and a volume of 99.3 cc with intravesical extension and cannot be separated from a rectal mass (blue arrows). (b): Confluent, matted, markedly enlarged retroperitoneal lymph nodes (red arrows) and dilated urinary collecting systems and ureters (green arrows).
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case_images: Abdominopelvic computed tomography (CT) scan with oral, rectal and intravenous contrast (Figure 2) showed markedly enlarged lymph nodes in the retroperitoneum encasing the abdominal aorta and iliac vessels and pelvic sidewalls.
case_images: Representative images from the colonoscopy. (a): Circumferential rectal mass approximately 70% obstructing with noted inflamed nodular and friable mucosa. (b): Normal colonic mucosa beyond the mass with noted colonic polyps shown in blue arrows. (c): Circumferential rectal mass with noted scope dilated colonic lumen. Multiple biopsies were taken.
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case_images: Figure 3 shows representative images from the colonoscopy.
case_images: Rectal mass, biopsy. (a): Haematoxylin and eosin (H & E) stain, 200x magnification. (b and c): H & E stain, 400x magnification.
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case_images: Biopsy of the rectal mass showed medium to large sized atypical cells with high nuclear to cytoplasmic ratio, arranged in poorly formed glands and as individual cells with enlarged, pleomorphic, hyperchromatic nuclei with prominent nucleoli (Figure 4).
case_images: Immunohistochemistry studies, 200xmagnification. (a): pancytokeratin/cytokeratin AE1/AE3. (b): CK7. (c): CK20. (d): CDX2. (e): p63. (f): NKX3.1. (g): synaptophysin. (h): chromogranin. (i): LCA. (j): TTF-1.
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case_images: TTF-1 and p63 (Figure 5). The histopathologic findings, together with the immunohistochemistry staining patterns favour the prostate gland as the primary site of malignancy.
case_images: Left lateral neck mass of patient decreased to approximately 4 x 4 cm in size after 1 month of treatment (previously 7 x 7.5 cm).
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case_images: After 1 month of treatment, there was drastic regression in the size of the neck mass to approximately 4 x 4 cm as shown in Figure 6.
case_images: Left lateral neck mass not anymore evident by inspection and barely palpable at approximately 1.5 x 2 cm in size after 5 months of treatment.
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case_images: After 5 months of treatment, the neck mass was not anymore evident by inspection and was barely palpable at approximately 1.5 x 2 cm in size (Figure 7).