80歲男性之同步原發典型何杰金氏淋巴瘤與攝護腺腺癌：一例罕見之病例報告

王嘉源¹、林巧文¹、賴昱維¹、薛又仁²、陳修聖¹、邱文祥³

¹臺北市立聯合醫院仁愛院區 外科部 泌尿科；²臺北市立聯合醫院和平婦幼院區 外科部 泌尿科；³新光醫療財團法人新光吳火獅紀念醫院 外科部 泌尿科

Synchronous Classic Hodgkin Lymphoma and Prostate Adenocarcinoma in an 80-year-old Male: A Case Report

Chia-Yuan Wang¹, Chyau-Wen Lin¹, Yu-Wei Lai¹, Thomas Y. Hsueh², Shiou-Sheng Chen¹, Allen W. Chiu³

¹Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan; ²Division of Urology, Department of Surgery, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan; ³Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Introduction: The coexistence of synchronous primary solid tumors and hematological malignancies is clinically rare. While lymphadenopathy in a patient with elevated PSA often suggests metastatic prostate cancer, clinicians must remain alert for atypical presentations. We report an incidental finding of systemic Hodgkin Lymphoma during the staging workup for prostate cancer in an 80-year-old patient.

Case presentation: An 80-year-old male presented with a 6-month history of two painless, protruding masses in the right inguinal region. His medical history was significant for psoriatic arthritis, previously treated with Etanercept (Enbrel) with poor clinical response. Initial investigations revealed an elevated PSA of 8.32 ng/mL. Digital rectal examination (DRE) revealed bilateral uneven surface of prostate. Computed tomography (CT) showed bulky lymphadenopathy in the right inguinal and external iliac regions.

An excisional biopsy of the right inguinal lymph node was performed, which unexpectedly revealed Classic Hodgkin Lymphoma. TRUS biopsy of the prostate confirmed Prostate Adenocarcinoma (Gleason Score 3+3=6). Bone scan showed no evidence of osseous metastasis. Further staging with 18F-FDG PET/CT demonstrated widespread, intense FDG uptake involving the mediastinal, hilar, supraclavicular, and retroperitoneal lymph nodes, confirming Ann Arbor Stage III/IV lymphoma. Given the advanced stage of the hematological malignancy versus the low-risk nature of the prostate cancer, systemic chemotherapy for lymphoma was prioritized.

Conclusion: This case highlights the diagnostic challenge of synchronous malignancies. When nodal distribution is atypical or discordant with PSA levels and tumor grade, pathological confirmation is mandatory to prevent misdiagnosis and ensure appropriate treatment prioritization for synchronous malignancies.