Hot dog lymphadenopathy of prostate cancer

Description

A man aged 77 years with diabetes and hypertension presented to our hospital with weight loss. The temperature was 36.7°, the blood pressure 117/68 mm Hg and the pulse of 63/min. Physical examination was normal. CT scan image with contrast enhancement of the abdomen revealed longitudinally fused bilateral massive para-aortic lymphadenopathy (figure 1A, B) with bilateral hydronephrosis. These images appeared to mimic a hot dog (figure 2A, B). Digital rectal examination identified the enlarged prostate. Prostate-specific antigen (PSA) was 517 ng/mL (normal range, 0–3.9 ng/mL). After he was admitted, a consultant urologist performed a prostate biopsy which showed the prostate cancer (figure 1C). A CT-guided needle biopsy of the para-aortic lymphadenopathy was also conducted and it revealed the similar histological finding of prostate cancer (figure 1D).¹ The patient underwent chemotherapy and hormone therapy and has been well at the time of the last follow-up at 3 months after the hospital discharge.

Learning points.

• Prostate cancer may metastasise through lymphatics to para-aortic lymph nodes.

• Malignant swelling of para-aortic lymph nodes can mimic the shape of a hot dog.

• It is occasionally important to make a histological diagnosis of the para-aortic lymphadenopathy because of the potential curability.

Figure 1.

Longitudinally fused bilateral massive para-aortic lymphadenopathy ((A) axial view; (B) coronal view) and histological findings with H&E stain ((C) prostate biopsy; (D) lymph node biopsy).

Figure 2.

A hot dog ((A) axial view; (B) longitudinal view).