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patients could reasonably be thought to be due to prostate
cancer-induced ascites. Until date, there have been only
16 published cases of malignant ascites in prostate
cancer and most cases presenting with malignant ascites
[5]
were associated with other metastatic sites, including the
bone, lymph nodes, omentum, rectal wall, liver, adrenal,
and pleural effusions. [6]

The mechanism of malignant ascites may include
peritoneal seedlings or lymphatic obstruction. Tumor
cells in an effusion may have exfoliated from the
primary lesion as evidenced by the positive cytology
after repeated cytological examinations of ascetic fl uid.
However, negative cytology could be very diffi cult
to make a differential diagnosis between benign
and malignant ascites, such as the current case. The
Figure 1: The computed tomography (CT) scan. The CT data show diffuse immunohistochemical staining can provide a valuable
nodular thickening (black arrow) of the omentum and ascites
adjunction. For example, immunostaining of prostatic
acid phosphatase and/or prostate specifi c antigen could
be useful in the diagnosis of prostate cancer with a
[7]
malignant effusion. Usually, malignant effusions in
prostate cancer patients are associated with very poorer
prognosis. [8]
References

1. Humphrey PA. Cancers of the male reproductive organs. In:
Stewart BW, Wild CP, editors. World Cancer Report. Lyon:
World Health Organization; 2014. p. 453-64.
2. Arnheim FK. Carcinoma of the prostate: a study of the
postmortem fi ndings in 176 cases. J Urol 1948;60:599-603.
3. Rapoport AH, Omenn GS. Dermatomyositis and malignant
effusions: Rare manifestations of carcinoma of the prostate.
J Urol 1968;100:183-7.
4. Megalli MR, Gursel EO, Veenema RJ. Ascites as an
unusual presentation of carcinoma of the prostate. J Urol
Figure 2: Hematoxylin and eosin staining of the omental biopsy.
Tissue section shows omental tissue infi ltrated by poorly differentiated 1973;110:232-4.
adenocarcinoma 5. Ani I, Costaldi M, Abouassaly R. Metastatic prostate cancer
with malignant ascites: A case report and literature review.
Can Urol Assoc J 2013;7:E248-50.
6. Saif MW. Malignant ascites associated with carcinoma of the
prostate. J Appl Res 2005;5:305-11.
7. Satz N, Joller-Jemelka HI, Grob PJ, Hofer C, Schmid E,
Knoblauch M. Tumor markers and immunomodulator
substances in ascites -- their value as screening and diagnosis
parameters. Schweiz Med Wochenschr 1989;119:762-5.
8. Kehinde EO, Abdeen SM, Al-Hunayan A, Ali Y. Prostate
a b cancer metastatic to the omentum. Scand J Urol Nephrol
Figure 3: (a) Immunohistochemical staining of tissue biopsy for pan-cytokeratin; 2002;36:225-7.
(b) prostatic specifi c antigen

indicating that there were effusions occurring in prostate How to cite this article: Saini R, Dodagoudar C, Talwar V, Singh S.
cancer patients without any involvements of the more Malignant ascites with omental metastasis: a rare event in prostate
common metastatic sites. Thus, if other benign (like cancer. J Cancer Metastasis Treat 2015;1:34-5.
tuberculosis in India) and malignant (especially Received: 11-09-2014; Accepted: 12-01-2015.
[4]
gastrointestinal) etiologies should be excluded, these Source of Support: Nil, Confl ict of Interest: None declared.

Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 1 ¦ April 15, 2015 ¦ 35