|Findings:Ultrasound exam showed and enlarged prostate with a heteroechoic pattern consistent with infiltrative disease. The sublumbar lymphnodes were enlarged, hypoechoic, and rounded in shape. This was highly suggestive of early metastasis. The remainder of the abdomen was within normal limits. Radiographs of the thorax were normal. There was no evidence of pulmonary metastasis or lymphadenopathy. A subtle periosteal reaction was noted on the caudal cortex of the distal humerus of both front limbs. This was a smooth non aggressive periosteal reaction. Radiographs of the distal rear limbs showed soft tissue swelling with a pallisading periosteal reaction along the abaxial margins of the 2nd and 5th digits extending up the limb on both sides of the tarsus and distal tibia. FNA of the prostate and sublumbar lymphnodes were obtained with ultrasound guidance.
|Impressions and Recommendations: A diagnosis of prostatic carcinoma with metastasis to the sublumbar lymphnodes and hypertrophic osteopathy was made. Hypertrophic osteopathy is an unusual osteoproductive disorder of the periosteum that affects the long bones of the extremities. It is usually secondary to cardiopulmonary disease/neoplasia. It can be seen with non thoracic diseases as well. Often the patients present with signs of listlessness and swollen distal extremities rather than symptoms related to the primary thoracic or abdominal disease. The pathogenisis of hyertrophic osteopathy is incompletely understood, but does result in subperiosteal new bone formation that starts at the digits and progresses toward the axial skeleton.