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1</a>&#41;&#46; On color Doppler&#44; there was high echo intensity throughout the entire lesion&#44; more intense on the periphery &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; As there were findings that raised suspicion&#44; such as heterogeneity&#44; the marked vascularity and the marked Doppler signal &#40;grade 3&#41;&#44; magnetic resonance imaging was performed&#46; This study revealed a round&#44; well-defined form measuring 1<span class="elsevierStyleHsp" style=""></span>cm&#44; with hyperintensity on T1-weighted images&#44; which pointed to a metastatic lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Diagnosis and Course</span><p id="par0010" class="elsevierStylePara elsevierViewall">While the clinical picture was being completed on the basis of the constitutional symptoms&#44; a biopsy of the skin lesion was carried out&#46; The analysis of 4 tissue cores&#44; measuring 0&#46;4&#44; 1&#46;2&#44; 1 and 0&#46;9<span class="elsevierStyleHsp" style=""></span>cm in length&#44; respectively&#44; and 0&#46;1<span class="elsevierStyleHsp" style=""></span>cm in diameter&#44; confirmed the presence of infiltration of the fibromuscular tissue by prostate-specific antigen &#40;PSA&#41;-positive metastatic adenocarcinoma cells&#46; In addition&#44; laboratory tests revealed a PSA level of 13<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#44; and transrectal ultrasound-guided biopsy of the prostate confirmed prostatic adenocarcinoma with distant cutaneous metastasis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comment&#47;discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">After skin cancer&#44; adenocarcinoma of the prostate represents the most common type of cancer in men and the second most common cause of death due to cancer&#46; Death is often associated with metastatic disease which&#44; in the case of prostatic adenocarcinoma&#44; typically involves the bones and lymph nodes&#46; It rarely affects the skin&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;2</span></a> Although the medical history and physical examination&#44; laboratory tests and routine pathology may indicate the prostate as the origin of the metastatic disease&#44; immunohistochemistry for PSA is often used to aid in establishing the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This case is useful in clinical practice in rheumatology because&#58; &#40;1&#41; the images can raise suspicion for the seriousness of a nodular lesion smaller than 1<span class="elsevierStyleHsp" style=""></span>cm because of its vascularity and heterogeneity&#59; &#40;2&#41; it highlights the importance of the rheumatologic examination room in the diagnosis of soft tissue tumors &#40;benign or malignant&#41; that rheumatologists should not disregard&#59; &#40;3&#41; cutaneous metastases of prostatic adenocarcinoma are very uncommon and&#44; in this case&#44; soft tissue ultrasound helped to orientate the extensive study of the neoplastic disease&#59; and &#40;4&#41; it is essential to identify the lesions on the basis of their ultrasonographic appearance and&#44; when in doubt&#44; the study should be extended to include magnetic resonance imaging&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Ethical Disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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