Vol 44 # 4 December 2012 - Kma.org.kw

December 2012
KUWAIT MEDICAL JOURNAL 344
Case Report
Prostatic Adenocarcinoma and Chronic
Lymphocytic Leukemia: A Case Report
Abdul-Razzaq A Wraikat 1 , Tariq N Aladily 2
1
Department of Hematopathology, Jordan University Hospital, Amman, Jordan
2
Department of Pathology, Jordan University Hospital, Amman, Jordan
Kuwait Medical Journal 2012; 44 (4): 344 - 346
ABSTRACT
We report a rare case of a collision tumor. Our patient was
found to have prostatic adenocarcinoma colliding with
chronic lymphocytic leukemia, with no previous risk factors
or even a clinical suspicion. We review the literature for
similar cases and make an attempt to address the possible
shared risk factors.
KEYWORDS: collision tumors, multiple primaries,
INTRODUCTION
Synchronous involvement of the same tissue by two
different tumors is rare, but has been well-reported [1] .
Many examples of collision tumors having either prostatic
adenocarcinoma or chronic lymphocytic leukemia were
described, but only very rarely showed both neoplasms
colliding together. Being a curious phenomenon which
causes confusion in the diagnosis and treatment for
physicians, with an ominous effect on the patient, we
report this case in order to look for possible common risk
factors and a proposed way of treatment.
CASE REPORT
A 76-year-old man, presented to the Jordan
University Hospital in December, 2008 complaining of
fatigue and weight loss of two months duration. He was
a known case of diabetes mellitus. Physical examination
demonstrated hepatosplenomegaly, but no enlarged
lymph nodes. No urological findings were evident in
history or physical examination. The initial workup
showed abnormal complete blood count numbers.
Hemoglobin concentration was 8.5 g/dl and the packed
cell volume (PCV) was 25%. The white blood count
was 22,000, out of which 77% were lymphocytes, while
neutrophils formed 21% of blood cells. Platelet count was
normal. The peripheral blood film showed microcytic
hypochromic anemia, abnormal lymphocytes and
normal platelets. Kidney and liver function tests were
normal, with the exception of mild hypoproteinemia.
Guaiac stool hemoccult test was negative. Urinalysis
was normal.
The peripheral blood film showed diffuse
lymphocytosis. The lymphocytes were small and
mature with numerous smudge cells and minimal
atypia. Astonishingly, a bone marrow trephine biopsy
demonstrated the same neoplastic lymphocytes
intermingling with aggregates of large epithelioid cells
(Fig. 1). Immunohistochemical study revealed the latter to
be of prostatic origin (Fig. 2). Flow cytometry confirmed
the diagnosis of chronic lymphocytic leukemia (CLL)
(Fig. 3).
The patient was retrospectively investigated for
prostatic carcinoma. Serum total prostate specific antigen
(PSA) was highly elevated (100), and pelvic magnetic
resonance image (MRI) scan detected a prostatic mass
and liver metastasis.
DISCUSSION
A collision tumor is defined as the co-existence of
two adjacent but histologically different malignant
neoplasms occurring in the same organ without
histological admixture or an intermediate cell
population zone [1] . It is termed collision tumor when
the components are present in the originating organ
and collision metastasis when they collide in a distant
site discontinuous from the original organ. When
both tumors fuse and intermingle to the extent that it
is difficult to distinguish between them, the process
then is called a composite tumor [1,2] . Another similar
phenomenon is the hybrid tumor, which is composed
of two different tumor entities, each of which conforms
with an exactly defined tumor category and has
an identical origin within the same topographical
area [3] . This is different from multiphasic tumor
which corresponds to one tumor entity with different
morphological patterns. Discordant tumors are two
Address correspondence to:
Tariq Aladily, MD, Department of Pathology, Jordan University Hospital, Amman, Jordan. PO Box 142725, Amman, Jordan 11814. Tel:
+962798837525, Fax: + 9626 5353388 E-mail: Tariq_nb@yahoo.com