Ma Qing-Fang, Ou Chun-Ying, Wang Qi-Hong, Wang Yong-Nan
Department of Neurosurgery, Xu Zhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China.
Department of Neurology, Xu Zhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China.
Int J Surg Case Rep. 2022 Sep;98:107493. doi: 10.1016/j.ijscr.2022.107493. Epub 2022 Aug 9.
Brain metastases from carcinoma of prostate are rare and only few cases with brain metastases preceding the diagnosis of carcinoma of prostate have been reported in the literature. Lesions of brain metastasis from prostate cancer had a large variety of imaging presentations and it is very difficult to distinguish them from the other types of brain occupying lesions. We report one case of metastatic prostatic adenocarcinoma of cerebellopontine angle presenting as acoustic neuroma, as the first clinical evidence of metastatic carcinoma of the prostate.
The 57-year-old male presented to the neurology clinic complaining of dizziness accompanied by right tinnitus, he was proposed to be diagnosed with acoustic neuroma, and the tumor resection was performed later in our neurosurgery department. The postoperative histopathological and immunohistochemical (IHC) examinations revealed a cerebellar pontine angle metastatic adenocarcinoma, which was then confirmed as prostate cancer metastasis. The patient refused surgical castration and only agreed to conservative treatment. The patient's condition continued to deteriorate, and he died 12 months after the initial presentation.
Brain metastasis is rare in prostate cancer, which accounts for only 0.2 % to 2 % of all brain metastases. Intracranial metastasis as the first clinical symptom of prostate cancer is extremely rare. In our article, we report the VIIIth and VIIth cranial nerves palsy for the first time, caused by brain metastases from prostate cancer, with symptoms similar to an acoustic neuroma. Prostate cancer most commonly spreads to the bones, including the skull, Cranial nerve palsy is caused by extensive invasion of the skull base. The serum PSA level is considered the most valuable tool to monitor the disease progression of patients with prostate cancer metastasis. A high PSA level significantly increases the tendency of prostate cancer to metastasize to the brain. A high Gleason score is believed to help determine the risk and likelihood of brain metastases in patients with prostatic carcinoma.
In our case, we initially report the VIIIth and VIIth cranial nerve palsy, mimicking an acoustic neuroma, caused by metastatic prostate carcinoma. For early diagnosis, the prostate should not be neglected as a possible source of the metastases in male patients presenting with brain metastases. High prostate specific antigen (PSA) level and high Gleason score can be useful parameters for the prediction of brain metastasis from prostate cancer. The PSA should play a vital role in distinguishing metastatic prostate carcinoma in male patients.
前列腺癌脑转移罕见，文献中仅报道了少数几例在前列腺癌诊断之前出现脑转移的病例。前列腺癌脑转移瘤有多种影像学表现，很难与其他类型的脑占位性病变区分开来。我们报告一例表现为听神经瘤的桥小脑角转移性前列腺腺癌病例，这是前列腺癌转移的首个临床证据。
一名57岁男性因头晕伴右耳鸣就诊于神经内科门诊，拟诊断为听神经瘤，随后在我院神经外科行肿瘤切除术。术后组织病理学和免疫组化（IHC）检查显示为桥小脑角转移性腺癌，后确诊为前列腺癌转移。患者拒绝手术去势，仅同意保守治疗。患者病情持续恶化，初诊后12个月死亡。
脑转移在前列腺癌中罕见，仅占所有脑转移的0.2%至2%。颅内转移作为前列腺癌的首个临床症状极为罕见。在我们的文章中，我们首次报告了由前列腺癌脑转移引起的第Ⅷ和第Ⅶ颅神经麻痹，症状类似于听神经瘤。前列腺癌最常转移至骨骼，包括颅骨，颅神经麻痹是由颅底广泛侵犯引起的。血清PSA水平被认为是监测前列腺癌转移患者疾病进展最有价值的工具。高PSA水平显著增加前列腺癌转移至脑的倾向。高Gleason评分有助于确定前列腺癌患者脑转移的风险和可能性。
在我们的病例中，我们首次报告了由转移性前列腺癌引起的类似于听神经瘤的第Ⅷ和第Ⅶ颅神经麻痹。为了早期诊断，对于出现脑转移的男性患者，不应忽视前列腺作为转移可能来源的情况。高前列腺特异性抗原（PSA）水平和高Gleason评分可能是预测前列腺癌脑转移的有用参数。PSA在鉴别男性患者转移性前列腺癌中应发挥重要作用。
