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Case Report

Malignant ascites with omental metastasis: a rare event in prostate
cancer

Rajeev Saini, Chandragouda Dodagoudar, Vineet Talwar, Sajjan Singh
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi 110085, India.
Correspondence to: Dr. Rajeev Saini, Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini,
New Delhi 110085, India. E-mail: rajeev.rajeev7@gmail.com

ABSTRACT
Prostate cancer is the most common type of male malignancy in the world and approximately 10-20% of prostate cancer shows
a metastatic disease at initial diagnosis commonly to the bones, vertebrae, ribs, long bones, and skull. However, prostate cancer
metastasis to the omentum with malignant ascites is extremely uncommon. In this study, we report such a case, which also
highlights a repeatedly negative ascetic fl uid cytology even with multiple omental metastatic nodules. The purpose of this case
report is to provide awareness to physicians for this rare occurrence.

Key words: Immunohistochemical staining, malignant ascites, omental metastasis, prostate cancer, prostatic specifi c antigen

Introduction One month after this regime of treatment, patient
presented with 10 days history of abdominal distension
Prostate cancer is the most common male malignancy in the and found to have gross ascites. A diagnostic and
world with an estimated 1,100,000 new cases and 307,000 therapeutic paracentesis was conducted and removed
cancer-related deaths in 2012. Although most prostate 1,500 mL straw colored fl uid. Fluid analysis showed
[1]
cancer patients have localized disease with a favorable to be exudate and cytology was negative for malignant
prognosis, advanced prostatic cancer metastasize frequently cells. Ascitic fl uid adenodeaminse titer and polymerase
to the bone and regional lymph nodes, but prostate cancer chain reaction showed negative for tuberculosis. Ascetic
metastasis to the omentum with malignant ascites is very fl uid was taken and tested for multiple times, but all
rare. In this study, we report such a rare case.
[2]
were negative. Moreover, esophageal-gastrodudenoscopy
Case Report and colonoscopy were normal . Contrast-enhanced CT
abdomen in March 2014 showed prostatic mass with
A 65-year-old man was initially diagnosed as prostate gross ascites with thickened omentum [Figure 1].
adenocarcinoma with Gleason score 7 (4 + 3 = 7 out 10) Bone scan shows no evidence of skeletal metastasis.
in 2004. The level of prostatic specifi c antigen (PSA) Serum and ascitic PSA were 316 ng/mL and
was 233 ng/mL at cancer diagnosis. He then underwent 175 ng/mL, respectively . A ultrasound-guided biopsy
bilateral orchiectomy and hormonal therapy with 50 mg of the thickened omentum and histology showed a
dose of bicalutamide, but discontinued after 5 months metastatic adenocarcinoma [Figure 2], which was
treatment. In 2009, his PSA level raised to 90 ng/mL, but immunohistochemically positive for cytokeratin (CK)
there was no evidence of metastasis detected by either and PSA [Figure 3] and focally positive for CK7,
computed tomography (CT) or bone scan. He was whereas negative for CK2. Patient was then planned for
again on bicalutamide treatment, but his PSA response Taxotere-based chemotherapy.
lasted for approximately 2 years. In December 2011,
bicalutamide treatment was discontinued, and Fosfestrol Discussion
was started. However, in November 2013, his PSA
level was increasing to 27.4 ng/mL and therefore, Although prostate cancer can metastasize to nearly
fosfestrol was discontinued and the patients were treated any organs in the body, metastasis without osseous
with ketoconazole and prednisolone. involvement is extremely rare. Arnheim showed in 1948
that in 176 postmortem cases, the bone, lymph nodes,
and lungs were the most common metastasis of prostate
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cancer, whereas the uncommon metastasis sites included
[2]
Quick Response Code: the adrenal gland, kidney, brain, pancreas, genitalia, and
Website:
www.jcmtjournal.com breast. Malignant effusion, whether pleural or peritoneal,
was an extremely rare. Moreover, Rapoport and
[2]
[3]
Omenn reviewed the autopsy of 523 prostate cancer
DOI:
10.4103/2394-4722.152767 cases and found that 13 cases had peritoneal deposits,
but with no other metastasis elsewhere in the body,
34 Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 1 ¦ April 15, 2015 ¦