Metastatic Prostatic carcinoma diagnosed on bone marrow aspirate and biopsy confirmed by Immunohistochemistry.

70 yrs. male presented with complaints of back pain and urinary incontinence. His basic hematology reports showed Hemoglobin of 15.7g/dl, Total WBC count-10,000 and platelet of 60 thousand. His serum prostate specific antigen levels was elevated with value more than 150ng/dl. Radiological findings of a Whole body Ga 68 PSMA PET CT scan showed PSMA avid enhancing component in the peripheral zone of the left lobe of prostate with multiple PSMA avid nodes noted above and below diaphragm. In view clinical suspicion of primary from prostate bone marrow was done for staging and initial tissue diagnosis. Peripheral smear showed thrombocytopenia with normocytic anemia and normal total counts.

Bone marrow aspirate with cellular marrow aspirate and imprint smear showed significant presence of many discrete clusters of atypical large cells arranged in glandular architecture with prominent nucleoli consistent with metastatic carcinoma(Figure -1,2).

Bone marrow Biopsy showed a cellular marrow with trilineage hematopoiesis with infiltration by clusters of atypical large cells arranged in acini/ glands with few showing necrosis confirmed a metastatic carcinoma (Figure 3, 4). As the radiological findings suggested a higher stage for the primary immunohistochemistry was requested for the primary diagnosis. Immunohistochemistry was performed on the bone marrow biopsy with a panel of pan CK, CK7, CK20, PSA, AMACR, NKX.3 and TTF1.  The metastatic tumor cells positive for PSA, AMACR and NKX.3 (Figure- 5, 6, 7, 8, and 9) and negative for other markers. This confirmed a prostatic origin for the primary.