Atypical Presentation of Metastatic Prostate Adenocarcinoma in the Presacral Space: A Case Report of Diagnostic Resection via the Kraske Approach.
Alex Tran, Sowsan Rasheid
✦ AI-curated · Sources linked
Case in brief
A 69-year-old man presented with hematuria and a 4-cm presacral mass, initially thought to be a primary neurogenic tumor based on MRI findings. Due to the mass's location, a preoperative biopsy was not performed, and the lesion was resected via the Kraske approach. Histopathological analysis revealed metastatic prostate adenocarcinoma, highlighting an occult primary tumor that would have changed management if diagnosed earlier.
What made this case unusual
The case features an isolated soft-tissue presacral metastasis from prostate adenocarcinoma, which is exceedingly rare and poorly characterized, complicating the diagnostic process.
Diagnostic / clinical pearl
Clinicians should include serum PSA testing in the evaluation of solid presacral masses in older male patients to avoid missing an occult prostate cancer diagnosis.
Why it matters
This case emphasizes the need for a thorough workup in atypical presentations of malignancy, as misdiagnosis can lead to significant management delays.