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).
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).
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 cases11. 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....
. Pathogenetic mechanisms include hematogenous spread and surgical seeding22. 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...
. A dural metastasis usually presents as a solitary mass with avid contrast enhancement. Bone erosion and nontraumatic subdural hematoma may rarely be seen33. 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...
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References
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1Guedes 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 -
2Lath 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 -
3Smith 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
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Publication in this collection
05 Sept 2019 -
Date of issue
Aug 2019
History
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Received
28 Nov 2018 -
Reviewed
05 Feb 2019 -
Accepted
20 Mar 2019