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Título

AN UNUSUAL PATHOLOGICAL FINDING OF ADENOCARCINOMA OF THE PROSTATE AND CHRONIC LYMPHOCITIC LEUKEMIA: A CASE REPORT

Introdução, Material, Método, Resultados, Discussão e Conclusões

Case report: A 71-year-old man, previously healthy, with asthenia, hyporexia and weight loss for three months. Tests showed increased PSA (2703) and lymphocytosis (43690 leukocytes with 59% differentiation). The patient was referred to an Oncohematology service for evaluation – immunophenotyping was compatible with Chronic Lymphocytic Leukemia (CLL), bone marrow biopsy confirmed spinal invasion by a malignant neoplasia and prostatic biopsy confirmed an acinar adenocarcinoma G9 (5 + 4). Computed tomography showed metastatic lesions in bones and pelvic and inguinal lymph nodes. Excisional biopsy of an inguinal lymph node confirmed the presence of lymphoproliferative disease associated with prostate adenocarcinoma metastasis. In a multidisciplinary discussion, no criteria for the treatment of CLL were identified and GnRH agonist was started. Considering the presence of a high volume of disease, chemotherapy was indicated based on docetaxel. Discussion: The association between prostatic adenocarcinoma and chronic lymphocytic leukemia is rare with a reported incidence of 1.2%. The most common finding of CLL is at random in prostatic biopsies as lymphocytic infiltrate associated with adenocarcinoma. The mention of nodal invasion of both diagnoses are infrequent. Different hypotheses can explain the relationship between prostatic cancer and CLL as the deficiency of anti-tumor immunity (default B lymphocytes, quantitative and qualitative abnormalities of the sub T populations) documented during the CLL, making genetic predisposition a predominant etiological factor. The presence of low-grade, low-stage CLL confirmed by hematological evaluation, and the simultaneous evidence of a prostatic adenocarcinoma, does not affect therapeutic management in relation to solid tumor or hematologic disease. Therefore, in the presence of prostate adenocarcinoma with a high volume of disease according to the ECOG-3805 study and with adverse prognostic factors - metastases present at diagnosis and Gleason score 8 - 10, randomized studies suggest the benefit in overall survival with the addition of docetaxel associated with suppression of testosterone levels, as demonstrated in ECOG-3805 and STAMPEDE. Final comments: This is a patient with the diagnosis of metastatic prostatic adenocarcinoma and CLL, whose association is rare and may be related to advanced age, altered antitumor immunity and genetic predisposition.

Palavras Chave

ADENOCARCINOMA OF THE PROSTATE, CHRONIC LYMPHOCITIC LEUKEMIA, BONES METASTASES