LETTER TO THE EDITOR
Year : 2007 | Volume
: 24 | Issue : 3 | Page : 157--158
Supraclavicular lymphadenopathy - initial manifestation of prostatic carcinoma
H Fernandes, CNR Naik, NT Marla, D Arora
Department of Pathology, Fr Muller's Medical College, Mangalore, Karnataka - 575002, India
Department of Pathology, Fr Muller«SQ»s Medical College, Kankandy, Mangalore, Karnataka - 575002
|How to cite this article:|
Fernandes H, Naik C, Marla N T, Arora D. Supraclavicular lymphadenopathy - initial manifestation of prostatic carcinoma.J Cytol 2007;24:157-158
|How to cite this URL:|
Fernandes H, Naik C, Marla N T, Arora D. Supraclavicular lymphadenopathy - initial manifestation of prostatic carcinoma. J Cytol [serial online] 2007 [cited 2019 Dec 9 ];24:157-158
Available from: http://www.jcytol.org/text.asp?2007/24/3/157/41911
To the Editor,
This is in reference to the article "Left cervical lymph node metastasis - An initial presentation of prostatic adenocarcinoma" published in Journal of Cytology volume 23,1. We wish to share our experience with a similar case.
The most common sites of metastatic spread of prostatic carcinoma are the regional lymph nodes and bones of the pelvis and axial skeleton. Enlarged lymph nodes, usually pelvic but rarely left supraclavicular or axillary can sometimes be a presenting symptom.
A fifty five year old male presented with a mass in the left side of neck present since 20 days. It measured 1.5 cm in diameter and was firm. Patient gave history of loss of weight and difficulty in evacuating bladder, which was present since 3 to 4 years.
Fine needle aspiration cytology performed from the lymph node showed cellular smears showing epithelial cells in sheets, clusters and in acinar pattern [Figure 1]. The nuclear chromatin was fine and the cytoplasm moderate in amount. A diagnosis of metastatic adenocarcinoma was offered. Per-rectal examination revealed nodular hard prostate. Ultrasonography showed a nodule in the prostate. No enlarged pelvic nodes were seen. PSA levels were 642 ng/ml. Prostatic biopsy showed features of adenocarcinoma of prostate [Figure 2]. A final diagnosis of prostatic adenocarcinoma with distant metastasis was made. Patient underwent bilateral orchidectomy two weeks after the biopsy and was put on hormonal treatment.
Cervical and supraclavicular lymph node involvement has been reported in 0.4% to 1% of all cases of metastatic prostate cancer.  However cervical lymphadenopathy as the initial presentation of prostatic carcinoma is rare. In supradiaphragmatic spread of carcinoma prostate, it has been postulated that tumour cells lodge in the nodes, which are close to the entry of thoracic duct into left subclavian vein by retrograde spread. 
Fine needle aspiration is recommended to determine the diagnosis because it has high sensitivity and specificity and can be easily performed. Possibility of prostate carcinoma should always be considered in the differential diagnosis of elderly men with cervical lymphadenopathy, even in the absence of lower urinary tract symptom. Once the diagnosis is established hormone treatment has been shown to be of benefit even in patients in the advanced stages of the disease. 
|1||Saitoh H, Hida M, Shimbo T, et al. Metastatic patterns of prostate cancer. Cancer 1984; 54:3078-84.|
|2||Wang HJ, Chang PH, Peng JP, Yu TJ, Yu. Presentation of prostatic carcinoma with cervical lymphadenopathy: report of three cases. Chang Gung Med J 2004; 27:8404.|
|3||Goktas S, Crawford ED. Optimal hormonal therapy for advanced prostatic carcinoma. Semin Oncol 1999; 26:162-73.|