Dural metastasis of prostate adenocarcinoma with spontaneous subdural hematoma: an unusual mimicker of meningioma

Metástase dural solitária de adenocarcinoma de próstata mimetizando meningioma: disseminação incomum de uma neoplasia frequente

A 65-year-old male presented with abrupt onset of right hemiparesis. He was previously diagnosed with advanced adenocarcinoma of the prostate. Magnetic resonance imaging showed an extra-axial expansile lesion, located in the left perirolandic region associated with a nontraumatic subdural hematoma. Histopathology and immunohistochemistry of the lesion revealed metastatic prostate adenocarcinoma (Figure 1 and 2).

Figure 1
Computed tomography shows an oval extra-axial lesion (black arrow) on the left parietal convexity, with intense and homogeneous enhancement in the post-contrast phase (a). Note the sclerotic bone associated (white arrow), suggesting osseous infiltration (b).

Figure 2
Magnetic resonance shows left perirolandic extra-axial expansile lesion (black arrow), hyperintense in T2-weighted images, associated with vasogenic edema (black arrowhead) and with sclerotic adjacent bone (white arrow) (a, b). Single-voxel proton spectroscopy showed absence of NAA and creatine peaks with increased choline (Cho) and large lipid/lactate peaks, suggesting metastatic origin (c). Also note left subudural hematoma (white arrowhead) (b, d).

Dural metastasis from prostate adenocarcinoma is a rare condition, responsible for 1% of all cases¹. Pathogenetic mechanisms include hematogenous spread and surgical seeding². A dural metastasis usually presents as a solitary mass with avid contrast enhancement. Bone erosion and nontraumatic subdural hematoma may rarely be seen³.

References

• ¹
  Guedes BDVS, Rocha AJ, Gama HPP, Silva CJ. Dural metastases from prostate carcinoma: A systematic review of the literature apropos of six patients. Eur J Radiol. 2011;80(2):236-40. https://doi.org/10.1016/j.ejrad.2010.06.007
  » https://doi.org/10.1016/j.ejrad.2010.06.007
• ²
  Lath CO, Khanna PC, Gadewar S, Patkar DP. Intracranial metastasis from prostatic adenocarcinoma simulating a meningioma. Australas Radiol. 2005;49(6):497-500. https://doi.org/10.1111/j.1440-1673.2005.01473.x
  » https://doi.org/10.1111/j.1440-1673.2005.01473.x
• ³
  Smith AB, Rushing EJ. From the radiologic pathology archives: mass lesions of the dura: beyond meningioma: radiologic-pathologic correlation. RadioGraphics. 2014 Mar-Apr;34(2):295-312. https://doi.org/10.1148/rg.342130075
  » https://doi.org/10.1148/rg.342130075

Publication Dates

• Publication in this collection
  05 Sept 2019
• Date of issue
  Aug 2019

History

• Received
  28 Nov 2018
• Reviewed
  05 Feb 2019
• Accepted
  20 Mar 2019