Meningeal Carcinomatosis in Metastatic Prostate Cancer: A Case Report (original) (raw)
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Surgical neurology, 2006
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A case report of prostate cancer with leptomeningeal metastasis
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Background: Prostate cancer is the most prevalent cancer in men. However, leptomeningeal involvement by prostate carcinoma is a rare event. Case: Here, we report a 69-year-old patient with castration-resistant metastatic prostate cancer who presented with headache and ataxia. Brain MRI revealed a huge invasive interaxial mass at right occipital lobe with diffuse thickening and enhancement of meninges, the arachnoid, and the pia mater, and he was diagnosed with leptomeningeal carcinomatosis. The patient received whole brain radiotherapy. Conclusion: Despite the fact that brain and leptomeningeal metastases are not very common in patients with prostate cancer, signs and symptoms of nervous system disorders should be assessed carefully, and consideration of such unusual metastases must be considered.
Clinical Case Reports, 2021
Despite the prostate cancer is the most prevalent men cancer, metastases to the central nervous system including leptomeningeal involvement by prostate carcinoma are a rare event. Here, we detected leptomeningeal carcinomatosis based on MRI findings in a 67-year-old patient with castration-resistant metastatic prostate cancer who presented paraplegia and paresthesia of both limbs. Prostate cancer is second only to lung cancer as a leading cause of cancer-related death in men. 1 Most men with prostate cancer have asymptomatic and indolent disease. In advanced stages, the most common locations of metastasis from the prostate are bone, lung, and liver. 2 Central
Leptomeningeal metastasis from prostate cancer
Tumori
Metastatic prostate carcinoma commonly involves bones and extrapelvic lymph nodes, with occasional visceral deposits. Central nervous system involvement is unusual and particularly the occurrence of leptomeningeal metastasis (LM) is extremely rare, with few cases described in the medical literature. The clinical presentation is characterized by multifocal neurological deficit and the prognosis is generally dismal, with survival ranging between 3 and 6 months. We report on a patient affected by LM due to prostate cancer who was treated with a combined-modality approach consisting of sequential chemotherapy and radiotherapy. A 70-year-old man was referred to our group for cognitive mental disorder, left-sided frontal headache and nausea; the patient had a previous history of metastatic prostate cancer. LM was diagnosed neuroradiologically with brain MRI and evidence of a detectable level of PSA in the cerebrospinal fluid. He was treated with docetaxel and prednisone for 3 cycles follo...
Meningeal carcinomatosis in solid tumors
The involvement of the leptomeninges by metastatic tumors can be observed in solid tumors, in which case it is termed meningeal carcinomatosis (MC), and in lymphoproliferative malignant disease. It is more common in breast and lung cancer, as well as melanoma, with adenocarcinoma being the most frequent histological type. MC is usually a late event, with disseminated and progressive disease already present and, it is characterized by multifocal neurological signs and symptoms. Diagnosis is based on the evaluation of clinical presentation, cerebrospinal fluid and neuroimaging studies.
Brazilian Journal of Case Reports
Acute headaches with red flags in patients with cancer may indicate metastasis or infection. This report describes a case of acute headache with red flags in a patient with metastatic prostate adenocarcinoma who presented a positive latex fixation test without pleocytosis in cerebrospinal fluid (CSF) analysis. Antifungal treatment was initiated based on the test's high accuracy combined with the patient’s clinical condition and radiological impression of infectious meningitis, although we could not exclude associated secondary neoplastic involvement. Clinical improvement was first observed on D4 of treatment. On D14, CSF examination revealed therapeutic efficacy but positive oncotic cytology. The patient subsequently had new episodes of headache with warning signs and magnetic resonance imaging showed leptomeningeal carcinomatosis. Although neurocryptococcosis and leptomeningeal carcinomatosis are rare neurological complications, they may coexist with overlapping symptoms.
Arquivos Brasileiros de Neurocirurgia, 2021
Introduction Cerebral metastases are the most common cancer of the central nervous system (CNS). Meningeal infiltration by neoplasms that did not originate in the CNS is a rare fact that is present in 0.02% of the autopsies. Epidemiologically, the radiological presentation mimicking a subdural hematoma is even more uncommon. We report a case of meningeal carcinomatosis by an adenocarcinoma of the prostate mimicking a chronic subdural hematoma. Case Report A 60-year-old male patient was diagnosed with prostate cancer in 2011. He underwent radical resection of the prostate, as well as adjuvant hormonal therapy and chemotherapy. Five years later, the patient presented peripheral facial paralysis that evolved with vomiting and mental confusion. Tomography and magnetic resonance imaging scans confirmed the subdural collection. At surgery, the dura was infiltrated by friable material of difficult hemostasis. The anatomicopathological examination showed atypical epithelial cells. The immunohistochemistry was positive for prostate-specific antigen (PSA) and other key markers, and it was conclusive for meningeal carcinomatosis by a prostate adenocarcinoma. Discussion Meningeal carcinomatosis presents clinically with headache, motor deficits, vomiting, changes in consciousness and seizures. The two most discussed mechanisms of neoplastic infiltration are the hematogenous route and retrograde drainage by the vertebral venous plexus.
2021
Brain metastasis from prostate cancer is rare, occurring in less than 1% of metastatic prostate cancer patients. Brain metastasis can cause edema, neurologic symptoms, and may be misdiagnosed as primary brain tumors on imaging. A 68-year-old male presented to the emergency department complaining of headaches, right-sided weakness, multiple falls, and a 45 pounds of unintentional weight loss. Computerized tomography (CT) scan without contrast of the head showed a 3.2 cm right frontal mass with edema suspicious for meningioma. Associated nonspecific bony lesions were found on CT of the abdomen and pelvis. Magnetic resonance imaging (MRI) of the brain showed a 2.8 cm right frontal mass with an enhanced dural tail. Preoperative labs were noteworthy for a hemoglobin of 9.7 and prostate-specific antigen (PSA) of 66.7 ng/ml. Craniotomy with resection of tumor was performed with a frozen sample diagnosed as meningioma. Permanent pathology with stains were positive for PSA and prostatic-specific acid phosphatase (PSAP), making the diagnosis of metastatic prostate adenocarcinoma. Postoperatively, nuclear bone scan showed uptake in the axial skeleton consistent with metastasis. After the diagnosis of metastatic prostate cancer was made, bicalutamide was administered followed by degarelix with plans to transition to leuprorelin one month later. This is to be followed up by whole brain radiation therapy (WBRT). PSA was 118.53 ng/ml three weeks after craniotomy, but prior to androgen deprivation therapy. Metastatic prostate cancer can present with neurological symptoms most commonly following spread to the axial skeleton and impingement of the spinal cord. Metastasis to the brain is rare and is usually associated with vague symptomatology depending on extent and location of the lesion. While brain metastasis can occur in known prostate cancer patients, this case shows that metastasis can occur prior to any formal prostate cancer diagnosis and can be mistaken for meningioma on imaging and frozen sectioning. Practitioners must be vigilant, and precautions should be taken to rule in metastatic prostate cancer as a possible cause for a brain lesion in patients of the appropriate demographics.
Meningeal carcinomatosis diagnosed during stroke evaluation in the emergency department
International journal of emergency medicine, 2011
A 70-year-old female presented to the emergency department with a 3-day history of intermittent dysphasia and right facial droop. Computed tomography (CT) and magnetic resonance imaging (MRI) were obtained, and the patient was found to have meningeal carcinomatosis, also known as leptomeningeal metastases. Meningeal carcinomatosis is a rare metastatic complication of some solid tumors and hematopoietic neoplasms, and has a median survival rate of 2.4 months. The role of the emergency physician is to appropriately diagnose this condition, treat emergent side effects, provide symptomatic relief, and ensure multi-disciplinary management.