==== Front Urol Case RepUrol Case RepUrology Case Reports2214-4420Elsevier S2214-4420(18)30231-610.1016/j.eucr.2018.07.015OncologyProstatic metastasis from intrahepatic cholangiocarcinoma Tosev Georgi georgi.tosev@med.uni-heidelberg.dea∗Schuetz Viktoria viktoria.schuetz@med.uni-heidelberg.deaNyarangi-Dix Joanne joanne.nyarangi-dix@med.uni-heidelberg.deaStenzinger Albrecht albrecht.stenzinger@med.uni-heidelberg.debStoegbauer Fabian fabian.stoegbauer@med.uni-heidelberg.debKulu Yakup yakup.kulu@med.uni-heidelberg.decRadtke Jan P. janphilipp.radtke@med.uni-heidelberg.deadTeber Dogu dogu.teber@med.uni-heidelberg.deaHatzinger Martin martin.hatzinger@diakonissen.deeSpringfeld Christoph christoph.springfeld@med.uni-heidelberg.defgKoehler Bruno C. bruno.koehler@nct.uni-heidelberg.defgHohenfellner Markus markus.hohenfellner@med.uni-heidelberg.deaa Department of Urology, University of Heidelberg, Heidelberg, Germanyb Department of Pathology, University of Heidelberg, Heidelberg, Germanyc Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germanyd Department of Radiology, German Cancer Research Center, Heidelberg, Germanye Department of Urology, Diakonissenkrankenhaus Mannheim, Mannheim, Germanyf Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germanyg Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany∗ Corresponding author. Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany. georgi.tosev@med.uni-heidelberg.de18 7 2018 9 2018 18 7 2018 20 90 91 1 7 2018 16 7 2018 © 2018 The Authors. Published by Elsevier Inc.2018This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Keywords Intrahepatic cholangiocarcinomaProstate metastasisTransurethral resectionHematuriaLUTSTumor angiogenesis ==== Body Abbreviations ICCintrahepatic cholangiocarcinoma MHmesohepatectomy TUR-Ptransurethral resection LUTSlower urinary tract symptoms ADRadrenalectomy TNMclassification of malignant tumor CKcreatine kinase ARandrogen receptor PSAprostatic specific antigen PCAprostate cancer GATA3transcription factor CA 19-9carbohydrate antigen AMACRalpha-methyl CoA racemase TTF-1Thyroid transcription factor Ki-67proliferation marker VEGFvascular endothelial growth factor Introduction Intrahepatic cholangiocarcinoma (ICC) is the second most frequently developed primary carcinoma of liver and considered to be an incurable and rapidly growing tumor with poor survival. They are biologically aggressive and they are frequently discovered in advanced stage. Common tumor metastasis sites for ICC include regional lymph nodes as well as liver metastasis as an indication of tumor recurrence. Only a few cases of ICC metastasizing to the male urogenital tract have previously been reported. Surgical removal is the only curative therapeutic method for treatment of such tumors. Case presentation A 77-year-old patient with a history of ICC, who has been treated with MH, cholecystectomy and right adrenalectomy (ADR) for centrally located liver tumor with an initial tumor classification of (TNM): pT1, pNx, L0, V0, G2 with positive resection margins (R1) in June 2016–9 months before the current evaluation - was admitted to a tertiary referral clinic due to intermittent episodes of hematuria and lower urinary tract symptoms (LUTS). During TUR-P a large suspicious mass involving the left lobe of the prostate was detected and subsequently resected. The examination of the prostate tissue showed perineural tumor propagation and lymphangiosis carcinomatosis. The tumor cell and the tumor tissue from the liver showed a strong positivity for CK 7, CK 19, GATA 3 and for AR, just a few tumor cells were also positive for CA 19–9. Furthermore large parts of the tumor also showed positivity for CK-20 and negativity for PSA, AMACR, synaptophysin and TTF1. The Ki-proliferation rate was considerable high with 75%. In conclusion the histological examination of the resected prostate and primary hepatic tissue proved the diagnosis of primary prostatic metastasis from ICC (Fig. 1A and B).Fig. 1 A) Histological aspect of tumor with tight gland complexes with partly distinctive tubular tumor formation B) Immunhistological positivity for CK 7 and weakly positive for CA 19–9. Discussion ICC is considered to be an incurable, rapidly lethal cancer. Long-term survival is only observed in patients with limited disease that have been resected with clear margins. The second pathological report of the prostate tissue revealed prostatic metastasis from ICC with identical origin. Irradiation therapy of the prostate in combination with adjuvant chemotherapy could be taken in consideration, if the prostate was the single origin of metastatic spread of tumor cells from a primary neoplasm.1 Prostate cancer (PCA) and ICC have the ability to secrete common growth factors like VEGF-C, which were overexpressed in both tumor entities, and promote lymphangiogenesis.2,3 Autocrine regulation of lymphangiogenic growth factors may elicit divers effects on angiogenesis in this case. Ki-67 index has demonstrated on multivariate analysis, to be a significant independent risk factor for poor prognosis in ICC4 and is also significantly up-regulated in PCA.5 The Ki-proliferation rate was considerable high in this case of ICC with 75%. The remarkable proliferation for progression and further development to a more aggressive malignancy in this particular case remains elusive. Conclusion This case report represents the first case of prostate metastasis from ICC described in literature. Conflicts of interest All authors declare no financial conflicts or conflict of interest with respect to this manuscript. ==== Refs References 1 Zietman A.L. Bae K. Slater J.D. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/american college of radiology 95-09 J Clin Oncol 28 7 2010 1106 1111 20124169 2 Xu L.B. Liu C. Gao G.Q. Nerve growth factor-β expression is associated with lymph node metastasis and nerve infiltration in human hilar cholangiocarcinoma World J Surg 34 5 2010 1039 1045 20119692 3 Muders M.H. Zhang H. Wang E. 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