Fig 1: TURP pathology: Prostatic adenocarcinoma with individually infiltrating cells in the left half of the micrograph (H&E;, x28)

Rapid PSA increase up to 250 ng/ml was observed within the next 6 months of follow-up. Anti-androgen treatment (Bicalutamide 50 mg per day) was added to LHRH analogue.

The patient suffered from sensation of maxillary fullness. Computed tomography (CT) of the paranasal sinuses in July 2003 showed a mass obstructing the right maxillary sinus which was regarded as metastasis (Figure 2). A 15 mm metastatic nodule was found in the right lobe of the liver at abdominal CT as well. Bone scintigraphy also demonstrated metastasis to the right maxilla, right clavicle and fourth and sixth lumbal vertebrae.

Fig 2: Maxillary metastasis seen on computed tomography

Maxillary sinus biopsy was performed to identify the origin of the mass. Pathological evaluation revealed poorly differentiated carcinoma in the sinus mucosa. Tumor cells were observed to form small groups or large nests at pathological examination. No obvious glandular formation was determined. Immunohistochemical study revealed diffuse PSA positivity in the described neoplastic cells confirming the metastasis from the prostatic adenocarcinoma (Figure 3).

Fig 3: Maxillary sinus biopsy: Metastatic neoplastic cells diffusely stained with PSA. Surface epithelium of the sinus mucosa is seen on the right border of the picture (arrow). (Immunohistochemistry, primary anti-PSA antibody, ABC, x28)

Palliative radiotherapy (20 days) to the maxillary region was administered to relieve the symptoms. After radiotherapy, maxillary fullness sensation disappeared. However, PSA progression was continued up to 940 ng/ml within a period of eight months. The patient died with disseminated disease at 32 months after diagnosis.

Renal cell carcinoma was reported as the most common cause of metastatic tumor to the paranasal sinuses [3]. Paranasal sinus metastases of the prostate cancer is reported in a literature review as 5% of all 123 sinus metastases [3]. Prostate carcinoma, which metastasizes to the cranium, is poorly differentiated and has poor prognosis [4]. Conveniently, our patient had locally advanced poorly differentiated carcinoma at the presentation, and PSA relapse and the metastasis occurred in a short period of time under treatment.

In maxillary tumors (primary or metastatic) pain and sensation of fullness are common symptoms as observed in our patient [4].

In maxillary metastasis due to prostate cancer, palliative radiotherapy is a reasonable option which provides significant degree of symptom relief.

1) Matsumoto I, Furusato M, Inomata I, et al. Prostatic cancer presenting as metastatic adenocarcinoma of sphenoid sinus. Acta Pathol Jpn 1986;36;1753-6.

2) Telera S, Carloia S, Cavallotti D, et al. Sphenoidal metastasis from prostate carcinoma. Case report and review of the literature. Neurochirurgie 2001;47:61-5.

3) Prescher A, Brors D. Metastases to the paranasal sinuses: case report and review of the literature. Laryngorhinootologie 2001;80:583-94.

4) Gil Sanz MJ, Gonzalez Enguita C, Roncales Badal A, et al. Metastasis in maxillary sinus as presentation form of adenocarcinoma of the prostate. Actas Urol Esp 1992;16:272-4.

5) Fortson JK, Bezmalinovic ZL, Moseley DL. Bilateral ethmoid sinusitis with unilateral proptosis as an initial manifestation of metastatic prostate carcinoma. J Natl Med Assoc 1994;86:945-8.