![]() ![]() The lymph node regressed significantly and clinically the patient was stable in the subsequent follow-ups with decreasing serum PSA level and free from obstructive uropathy symptoms. Immunostaining of the supraclavicular lymph node with (PSA highlighting tumor cell positivity, immunohistochemstiry (IHC) x40 in prostate biopsy ( A) and supraclavicular lymph node, IHC x20 ( B)Ī month later, the patient underwent surgical androgen deprivation therapy (ADT) with bilateral total orchiectomy and later kept on chemotherapy including casodex. Abdominopelvis computed tomography scan was ordered but due to financial constraints, the patient was unable to afford, thus the staging was done by combination of the clinical presentation of the patient (T3) as the prostate capsule was hard with an extra-capsular extension (N3) due to the presence of supraclavicular lymph node involvement and (M1a) for the presence of osteoblastic lesions on the bone from the X-ray ( Fig. 1B) however, chest X-ray was normal ( Fig. Kidney, ureter and bladder (KUB) X-ray revealed multiple osteoblastic lesions on the iliac wings and lumbar vertebrae ( Fig. Other systems examination was unremarkable.Ībdominal pelvic ultrasound showed right moderate hydronephrosis with multiple pelvic masses that were separate from heterogeneous prostatomegaly ( Fig. Digital rectal examination revealed hard, nodular prostate on both lobes with obliteration of median sulcus. Abdominal examination revealed no organomegaly, no palpable masses. There was no any other peripheral lymph node enlargement. A transverse incision scar associated with a 3 × 4 cm, firm, non-tender lump with irregular surface in the left supraclavicular region between the two heads of the sternocleidomastoid muscle was noted. On physical examination, he was fully conscious his vital signs were all within normal limits. However, he denied the history of blood in urine. There, the patients reported that he was apparently well until 6 months ago when he started to experience lower urinary tract symptoms, which included urgency, weak stream, straining, sensation of incomplete bladder emptying, hesitancy, intermittency and increased frequency of micturition both during day and night time. The patient was then transferred to our facility for further management. ![]() He denied history of blood in urine, prior trauma on his back, weakness of the lower limbs, loss of consciousness, headaches or difficulties in breathing or swallowing. These symptoms were associated with lower back pain however, there was no aggravating or relieving factor. The patient also reported lower urinary tract symptoms, which were characterized by urgency, weak stream, straining and increased frequency of micturition. He attended at a local health facility where a supraclavicular lymph node incisional biopsy was done, and the histopathology report suggested the diagnosis of metastatic adenocarcinoma, most likely from the prostate. The swelling was painless, progressively increasing over time. CASE SERIES Case number 1Īn 80-year-old male presented with left supraclavicular swelling, which was started gradually. We report two rare cases of prostate cancer that presented initially with asymptomatic left supraclavicular swelling. African patients are likely to present with more advanced disease compared to Caucasians. Other primary cancers that rarely metastasize to cervical nodes include kidney, lung and breast. ![]() Neck lymph node is common site for metastasis of malignances of head and neck. Among the few cases of supraclavicular lymph node metastasis reported, left supraclavicular node is the most common site. Metastasis to non-regional supraclavicular lymph node has been documented but is extremely rare presentation of prostate cancer. Regional lymph node is the most common site of metastasis, other sites includes skeletal and lungs. The clinical presentation varies widely from asymptomatic early disease to metastatic symptoms. Prostate cancer is one of the most common cancers affecting males with adenocarcinoma being the most common histological type accounting for >90%. ![]()
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