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A 72-year-old male with a history of systemic hypertension, asthma, chronic obstructive pulmonary disease (COPD), and hyperlipidemia presents with diffuse patches of cutaneous depigmentation. A shave biopsy of different regions of depigmented skin indicated vitiligo. The patient was prescribed Opzelura (ruxolitinib) 1.5% topical cream as well as tacrolimus 0.1% topical ointment for vitiligo. He also had a history of prostate cancer. A prostate biopsy revealed three sites of prostatic adenocarcinoma with a Gleason score of 6 and a Prostate Imaging-Reporting and Data System (PI-RADS) score of 2. The patient remained in active surveillance for prostate cancer without treatment, due to its low severity. A subsequent biopsy five years later revealed a decrease in prostate cancer prevalence, with cancer present in only one core and at a lower severity. The purpose of this case presentation is to discuss possible links between vitiligo and prostate cancer, as well as their shared mechanisms and pathways., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Siwicki et al.)

Paraneoplastic pemphigus (PNP) is a rare, autoimmune, blistering condition defined by severe stomatitis, polymorphous cutaneous eruptions, and underlying neoplasms. PNP associated with solid cancer is extremely rare. An association with prostate adenocarcinoma remains exceptional. We describe a 69-year-old patient with recalcitrant PNP associated with prostate adenocarcinoma showing spectacular response immediately after associating hormonotherapy with conventional immunosuppressive drugs., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Moata et al.)

Hypercalcemia of malignancy is commonly associated with several malignancies, but its existence in prostate cancer is an uncommon finding. The concurrent existence of a parathyroid adenoma and a history of hypercalcemia over several decades further adds to the enigma. Our case is of an 82-year-old man with a history of prostate cancer who presented to the endocrinology clinic with hypercalcemia. His PET-CT showed osteolytic metastasis to the T10 vertebrae which were presumed to be the cause of his high serum calcium. Further investigations revealed increased parathyroid hormone-related peptide (PTHrP). Denosumab therapy was started but his calcium remained elevated and hence, he underwent palliative radiation therapy. A follow-up PET-CT revealed significant disease regression and his serum calcium decreased from 11mg/dL to 10mg/dL. However, one month post radiation his serum calcium started showing an upward trend. Further investigations revealed an elevated parathyroid hormone (PTH) and an ultrasound of the thyroid revealed parathyroid adenoma. The patient subsequently underwent a parathyroidectomy with resolution of hypercalcemia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Jatoi et al.)

A nephrogenic adenoma is a benign lesion consisting of the proliferation of tubules and glands in the urinary tract. The lesion, thought to be originated from renal tubules, is commonly seen in the urinary bladder. Microscopically, nephrogenic adenoma is composed of a proliferation of small tubules and microcysts encircled by a narrow rim of basement membrane-like hyaline material. There are tubules and microcysts lined by atrophic to undulating hobnail-appearing epithelial cells with bland nuclei and pale eosinophilic to clear cytoplasm. Focal cellular atypia characterized by somewhat coarse chromatin and prominent nucleoli may be present. The stroma is edematous and reveals a granulation tissue-like appearance. By immunohistochemical staining, nephrogenic adenoma is positive for PAX-2, PAX-8, P504S (α-methylacyl-CoA racemase), pan cytokeratin AE1/AE3, CK7, CAM5.2, epithelial membrane antigen (EMA), CD10, and napsin A. Occasionally the lesions are incidentally encountered in the prostatic urethra, which may lead to a misdiagnosis as prostatic adenocarcinoma, clear cell adenocarcinoma or urothelial carcinoma of the urinary bladder. Herein we present a case of nephrogenic adenoma which has been incidentally found in a transurethral resection of a prostate specimen for the management of benign prostatic hypertrophy. The evaluation of morphology, immunohistochemistry, and differential diagnoses have also been discussed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Beeter et al.)

Tumor-to-tumor metastasis is defined as when metastasis from a primary tumor (donor) grows in a different primary neoplasm (recipient). Due to the structure of the thymus and the low incidence rate, thymic epithelial neoplasm has been rarely described in the literature as a recipient for metastases.In this report,a patient with advanced prostatic cancer and under control after chemo/hormone therapy was directed to our thoracic surgery unit for an anterior mediastinal mass detected during the staging workup for prostate disease. A limited uptake at fluorodeoxyglucose-positron emission tomography (FDG-PET) in the mediastinal lesion, while the surrounding tissue showed diffusely negative hypermetabolism, suggested a second primary thymic epithelial tumor with a possible carcinomatous differentiation. A thymectomy through a median sternotomy was carried out. Histopathological analysis after thymectomy revealed a type A thymoma with multiple elements of prostate adenocarcinoma within it. The foci of prostate adenocarcinoma were co-located in the context of the thymoma, revealing what is defined as a tumor-to-tumor metastasis.To our knowledge, this is the first report describing a thymoma as the recipient of metastases coming from a primary extrathoracic tumor without the involvement of other thoracic organs., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Furia et al.)

Prostate carcinoma is one of the most common malignancies in the elderly male population in India as well as worldwide, and its incidence has been on the rise in the younger age groups as well. The annual incidence rate of prostate cancer in India ranges from 5.0 to 9.1 per 100,000 people. It commonly metastasizes to the bone, regional lymph nodes, and in rare cases, to the lung, liver, and brain. Pulmonary manifestations of metastatic prostate carcinoma are rare with pulmonary lesions being part of the initial pattern of metastasis in only 2% of prostate malignancies. We report the case of a 53-year-old male who presented with breathlessness and hemoptysis, which was initially diagnosed as pulmonary tuberculosis and later found to be a case of metastatic prostatic adenocarcinoma., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Vohra et al.)

Hemophagocytic lymphohistiocytosis (HLH) is caused by excessive immune activation. It can be primary in the setting of genetic defects or secondary in the setting of infection, inflammation, and malignancy. Here we present the fourth reported case of secondary HLH in association with prostatic adenocarcinoma and the diagnostic challenges of this rare, life-threatening condition. This is a 78-year-old male who presented to the hospital with fever and generalized weakness for three days and found to have splenomegaly, pancytopenia, markedly elevated transaminases, and ferritin. Bone marrow biopsy revealed hemophagocytes. He underwent an extensive evaluation to identify the etiology. Para-aortic lymph node biopsy was consistent with prostatic adenocarcinoma. The diagnosis of HLH needs a high index of suspicion because the presentation is nonspecific. HLH is a rapidly progressive and potentially fatal condition underscoring the need for a prompt evaluation if this condition is suspected., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Rajapakse et al.)

Brain metastasis from prostate cancer is rare, occurring in less than 1% of metastatic prostate cancer patients. Brain metastasis can cause edema, neurologic symptoms, and may be misdiagnosed as primary brain tumors on imaging. A 68-year-old male presented to the emergency department complaining of headaches, right-sided weakness, multiple falls, and a 45 pounds of unintentional weight loss. Computerized tomography (CT) scan without contrast of the head showed a 3.2 cm right frontal mass with edema suspicious for meningioma. Associated nonspecific bony lesions were found on CT of the abdomen and pelvis. Magnetic resonance imaging (MRI) of the brain showed a 2.8 cm right frontal mass with an enhanced dural tail. Preoperative labs were noteworthy for a hemoglobin of 9.7 and prostate-specific antigen (PSA) of 66.7 ng/ml. Craniotomy with resection of tumor was performed with a frozen sample diagnosed as meningioma. Permanent pathology with stains were positive for PSA and prostatic-specific acid phosphatase (PSAP), making the diagnosis of metastatic prostate adenocarcinoma. Postoperatively, nuclear bone scan showed uptake in the axial skeleton consistent with metastasis. After the diagnosis of metastatic prostate cancer was made, bicalutamide was administered followed by degarelix with plans to transition to leuprorelin one month later. This is to be followed up by whole brain radiation therapy (WBRT). PSA was 118.53 ng/ml three weeks after craniotomy, but prior to androgen deprivation therapy. Metastatic prostate cancer can present with neurological symptoms most commonly following spread to the axial skeleton and impingement of the spinal cord. Metastasis to the brain is rare and is usually associated with vague symptomatology depending on extent and location of the lesion. While brain metastasis can occur in known prostate cancer patients, this case shows that metastasis can occur prior to any formal prostate cancer diagnosis and can be mistaken for meningioma on imaging and frozen sectioning. Practitioners must be vigilant, and precautions should be taken to rule in metastatic prostate cancer as a possible cause for a brain lesion in patients of the appropriate demographics., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Son et al.)