Ajmal Namra, Deng Yutao, Kenyon Lawrence C, Curtis Mark T, Dispagna Mauro, Izes Joseph, Li Li
Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, USA.
Department of Pathology, Cooper University Hospital, Camden, USA.
Diagn Pathol. 2024 Oct 1;19(1):132. doi: 10.1186/s13000-024-01554-6.
Brain metastasis from prostate adenocarcinoma (PCa) is rare, often leading to death within a year. Its infrequent occurrence and atypical histopathologic features contribute to lower consideration in the differential diagnosis of tumor brain metastasis. This study aims to assess the clinical characteristics and distinctive histopathologic features of metastatic PCa in the brain for timely and enhanced diagnostic accuracy.
A retrospective search spanning 20 years (2003-2022) was conducted on our archives and identified 21 cases diagnosed as "metastatic prostate adenocarcinoma (mPCa)" in brain biopsies and resections. All existing slides were thoroughly reviewed to evaluate the histopathology of the mPCa.
The mean age at presentation for brain metastasis was 70 years. Of 21 cases, 5 were dural-based lesions, 16 were true intraparenchymal metastases, including 2 sellar/suprasellar masses, 3 frontal, 3 temporal, 3 occipital, 1 cerebellum, and 4 involving multiple brain lobes. The average interval between initial diagnosis and brain metastasis was 90.75 months. Notably, brain metastasis was the initial presentation for one patient, while another patient, initially diagnosed with prognostic grade group (GG) 2 PCa in 1/12 cores, presented with isolated brain metastasis two years later. Architecturally, tumor cells were arranged in sheets or nests in most cases; however, four cases showed histologic cribriform patterns, and five displayed papillary architecture. Cytohistology varied from uniform monomorphic to highly pleomorphic cells with prominent nucleoli (8/19) and high mitotic activity. Interestingly, 1 case showed small round blue cell morphology, another had focal areas of rhabdoid and spindle cell differentiation, and 6 had cytoplasmic clearing. Almost half of the cases (47%) showed necrosis.
mPCa to the brain can present with variable histomorphology. Therefore, consideration of mPCa in the differential diagnosis of metastatic brain lesions, even with non-suggestive imaging, is imperative in male patients with or without a history of primary disease. Accurate and prompt diagnosis is crucial, given the recent advancements in treatment that have improved survival rates.
前列腺腺癌（PCa）脑转移罕见，常导致患者在一年内死亡。其发生率低以及组织病理学特征不典型，使得在肿瘤脑转移的鉴别诊断中较少被考虑。本研究旨在评估脑转移性PCa的临床特征和独特的组织病理学特征，以提高诊断准确性并实现及时诊断。
对我们的档案进行了为期20年（2003年至2022年）的回顾性检索，在脑活检和切除标本中确定了21例诊断为“转移性前列腺腺癌（mPCa）”的病例。对所有现有切片进行了全面复查，以评估mPCa的组织病理学。
脑转移患者的平均就诊年龄为70岁。21例中，5例为硬脑膜病变，16例为真正的脑实质内转移，包括2例鞍区/鞍上肿块、3例额叶、3例颞叶、3例枕叶、1例小脑以及4例累及多个脑叶。初次诊断至发生脑转移的平均间隔时间为90.75个月。值得注意的是，1例患者以脑转移为首发表现，而另1例患者最初在1/12个穿刺核心中被诊断为预后分级组（GG）2级PCa，两年后出现孤立性脑转移。在结构上，大多数情况下肿瘤细胞呈片状或巢状排列；然而，4例显示组织学筛状模式，5例呈现乳头状结构。细胞组织学表现从均匀的单形性细胞到具有明显核仁（8/19）和高有丝分裂活性的高度多形性细胞不等。有趣的是，1例表现为小圆形蓝细胞形态，另1例有局灶性横纹肌样和梭形细胞分化区域，6例有细胞质透明区。几乎一半的病例（47%）出现坏死。
脑转移性PCa可呈现多种组织形态学表现。因此，在男性患者中，无论有无原发疾病史，即使影像学表现不支持，在转移性脑病变的鉴别诊断中也必须考虑mPCa。鉴于近期治疗进展提高了生存率，准确及时的诊断至关重要。
