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Vojnosanitetski pregled 2023 Volume 80, Issue 6, Pages: 538-542
https://doi.org/10.2298/VSP220416087L
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What can hide an enlarged lymph node of a patient with prostatic adenocarcinoma?

Lakić Tanja ORCID iD icon (University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia + University Clinical Center of Vojvodina, Center for Pathology and Histology, Novi Sad, Serbia)
Šunjević Milena ORCID iD icon (University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia + University Clinical Center of Vojvodina, Center for Pathology and Histology, Novi Sad, Serbia), milena.sunjevic@mf.uns.ac.rs
Ilić Aleksandra (University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia + University Clinical Center of Vojvodina, Center for Pathology and Histology, Novi Sad, Serbia)
Ilić-Sabo Jelena ORCID iD icon (University Clinical Center of Vojvodina, Center for Pathology and Histology, Novi Sad, Serbia + University of Novi Sad, Faculty of Medicine, Department of Histology and Embryology, Novi Sad, Serbia)
Radosavkić Radosav (University of Novi Sad, Faculty of Medicine, Department of Forensic Medicine, Novi Sad, Serbia + University Clinical Center of Vojvodina, Center for Forensic Medicine, Toxicology and Molecular Genetics, Novi Sad, Serbia)

Introduction. Adenocarcinoma is the most common prostatic malignancy, where clinical management, the Gleason score, and recent updates in prostate cancer staging play critical roles. Mantle cell lymphoma (MCL) originates from the malignant transformation of B lymphocyte in the outer edge of the lymph node follicle, with pathognomonic over-expression of cyclin D1. We present a rare case of two simultaneous neoplasms occurring in the same patient. Case report. During the hospital preoperative examinations in a 68-year-old patient planned for radical prostatectomy, using multislice computed tomography, a tumor mass confined to the prostate, but also excessive lymph node enlargement, was revealed. Tissue specimens were analyzed after the hematoxylin and eosin staining was performed, as well as an immunohistochemical (IH) biomarker panel. Having performed a thorough histological examination, a diagnosis of prostatic adenocarcinoma was made, with a Gleason score 3 + 4 = 7 and Grade Group 2 of the International Society of Urological Pathology (ISUP). Microscopic analysis of lymph node involvement showed unexpected, diffuse proliferation of small lymphoid cells with irregular nuclei, wide mantle zone, and hyalinized blood vessels. After using IH staining for specific markers, another diagnosis was set, and it was non-Hodgkin MCL. Conclusion. A prostatic adenocarcinoma can rarely coexist with an undiagnosed lymphoproliferative disease, such as non-Hodgkin MCL in our case.

Keywords: adenocarcinoma, comorbidity, diagnosis, immunohistochemistry, lymphoma, mantle-cell, prostatic neoplasms

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