Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the a...Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the axial skeleton and regional lymph nodes. Initial presentation of the metastatic disease with cervical or supraclavicular lymphadenopathy is rarely reported. We report 3 cases of metastatic cancer of the prostate presenting initially to physicians with huge cervical and supraclavicular lymph nodes enlargement which on biopsy revealed metastatic adenocarcinoma. On further evaluation, there were non-bothersome storage symptoms, elevated prostate specific antigen and abnormal digital rectal examination. Transrectal ultrasound (TRUS)-guided biopsy of hypoechoic nodules revealed high-grade adenocarcinoma of the prostate on histopathological examination. The cervical and supraclavicular lymphadenopathy resolved after commencement of androgen deprivation therapy. We advocate for prostate cancer screening in African men above 50 years of age presenting with cervical or supraclavicular lymphadenopthy to primary care physicians even in the absence of lower urinary tract symptoms.展开更多
Background The specificity and precision of lymphadenopathy assessment using US, CT and MRI are generally unsatisfactory, while fluorodeoxyglucose-positron emission tomography/computed tomography （18F-FDG PET/CT） ca...Background The specificity and precision of lymphadenopathy assessment using US, CT and MRI are generally unsatisfactory, while fluorodeoxyglucose-positron emission tomography/computed tomography （18F-FDG PET/CT） can support this process by providing additional information about the lymph node features. However, which image features of 18F-FDG PET/CT play the key role in the diagnosis and cutoffs of malignant cervical lymphadenopathy still needs to be determined by further studies. Our study aimed to identify 18F-FDG PET/CT abnormalities that would assist in making a reliable diagnosis of malignant cervical lymphadenopathy in enlarged cervical lymph nodes of patients with unknown primary diseases. Methods One hundred and ninety-one consecutive patients of cervical lymphadenopathy with unknown primary causes were examined by 18F-FDG PET/CT from May 2007 to October 2011 and a definite diagnosis was established by pathologic biopsy. 18F-FDG PET/CT images were evaluated to identify the relevant abnormalities. All image features were analyzed by optimal scale regression tests to determine the important factors that were predictive for the diagnosis of malignant cervical lymphadenopathy and the cutoffs. Results The factors studied in 18F-FDG PET/CT images for predicting malignant cervical lymphadenopathy were sex, age, node location, size, shape, margins, maximum standard uptake value （SUV）, mean SUV, FDG uptake pattern and number of nodes. It was found that mean SUV, maximum SUV, FDG uptake pattern, location, size and margins were the important risk factors of cervical lymph nodes that could predict malignant cervical lymphadenopathy. Signs of mean SUV〉2.5 （or maximum SUV〉3.5）, nodular FDG uptake pattern, location of IIA, III, IV, VB, VI and VII regions, size〉1.5 cm and vague margins had their optimal diagnostic accuracy （Ac） and Youden index （YI）, further, combination of any three factors of these six important risk factors would led to the best diagnosticAc of 96% and YI of 0.93. Conclusion展开更多
文摘Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the axial skeleton and regional lymph nodes. Initial presentation of the metastatic disease with cervical or supraclavicular lymphadenopathy is rarely reported. We report 3 cases of metastatic cancer of the prostate presenting initially to physicians with huge cervical and supraclavicular lymph nodes enlargement which on biopsy revealed metastatic adenocarcinoma. On further evaluation, there were non-bothersome storage symptoms, elevated prostate specific antigen and abnormal digital rectal examination. Transrectal ultrasound (TRUS)-guided biopsy of hypoechoic nodules revealed high-grade adenocarcinoma of the prostate on histopathological examination. The cervical and supraclavicular lymphadenopathy resolved after commencement of androgen deprivation therapy. We advocate for prostate cancer screening in African men above 50 years of age presenting with cervical or supraclavicular lymphadenopthy to primary care physicians even in the absence of lower urinary tract symptoms.
文摘Background The specificity and precision of lymphadenopathy assessment using US, CT and MRI are generally unsatisfactory, while fluorodeoxyglucose-positron emission tomography/computed tomography （18F-FDG PET/CT） can support this process by providing additional information about the lymph node features. However, which image features of 18F-FDG PET/CT play the key role in the diagnosis and cutoffs of malignant cervical lymphadenopathy still needs to be determined by further studies. Our study aimed to identify 18F-FDG PET/CT abnormalities that would assist in making a reliable diagnosis of malignant cervical lymphadenopathy in enlarged cervical lymph nodes of patients with unknown primary diseases. Methods One hundred and ninety-one consecutive patients of cervical lymphadenopathy with unknown primary causes were examined by 18F-FDG PET/CT from May 2007 to October 2011 and a definite diagnosis was established by pathologic biopsy. 18F-FDG PET/CT images were evaluated to identify the relevant abnormalities. All image features were analyzed by optimal scale regression tests to determine the important factors that were predictive for the diagnosis of malignant cervical lymphadenopathy and the cutoffs. Results The factors studied in 18F-FDG PET/CT images for predicting malignant cervical lymphadenopathy were sex, age, node location, size, shape, margins, maximum standard uptake value （SUV）, mean SUV, FDG uptake pattern and number of nodes. It was found that mean SUV, maximum SUV, FDG uptake pattern, location, size and margins were the important risk factors of cervical lymph nodes that could predict malignant cervical lymphadenopathy. Signs of mean SUV〉2.5 （or maximum SUV〉3.5）, nodular FDG uptake pattern, location of IIA, III, IV, VB, VI and VII regions, size〉1.5 cm and vague margins had their optimal diagnostic accuracy （Ac） and Youden index （YI）, further, combination of any three factors of these six important risk factors would led to the best diagnosticAc of 96% and YI of 0.93. Conclusion
