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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(02): e167-e173
DOI: 10.1055/s-0040-1713092
Case Report | Relato de Caso

Meningeal Carcinomatosis for Prostate Adenocarcinoma Mimicking Chronic Subdural Hematoma: Case Report and Literature Review

Carcinomatose meníngea de adenocarcinoma de próstata mimetizando hematoma subdural crônico: Relato de caso e revisão da literatura
Tiago Silva Holanda Ferreira 
1   Department of Neurosurgery, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
,
Gilnard Caminha de Menezes Aguiar 
1   Department of Neurosurgery, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
,
Daniel Gurgel Fernandes Távora 
2   Department of Radiology, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
,
Lucas Alverne Freitas de Albuquerque 
1   Department of Neurosurgery, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
,
Stélio da Conceição Araújo Filho
1   Department of Neurosurgery, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
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Abstract

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.

Conclusion Variable clinical presentations may occur in dural metastases; however, the radiological presentation as subdural hematoma is rare. There are few descriptions of cases like this one in the literature.

To support the diagnosis, the previous medical history is as important as the complementary exams and the radiological findings, because the symptoms are common at the neurological emergency. To our knowledge, this is the first report of a prostate neoplasm mimicking chronic subdural hematoma in Brazil.

Resumo

Introdução Metástases cerebrais são o tipo mais comum de câncer do sistema nervoso central (SNC). A infiltração meníngea por neoplasias não originárias do SNC é fato raro, estando presente em 0.02% das autópsias.

Epidemiologicamente, a apresentação radiológica mimetizando hematoma subdural é ainda mais incomum. Nós relatamos um caso de carcinomatose meníngea por adenocarcinoma de próstata mimetizando hematoma subdural crônico.

Relato de Caso Homem de 60 anos foi diagnosticado com câncer de próstata em 2011. O paciente foi submetido a prostatectomia radical, bem como a quimioterapia e terapia hormonal adjuvante.

Cinco anos depois, ele apresentou paralisia facial periférica, que evoluiu com vômitos e confusão mental. Tomografia e ressonância magnética confirmaram coleção subdural.

Na cirurgia, a dura-máter encontrava-se infiltrada por material de difícil hemostasia. O exame anatomopatológico descreveu células epiteliais atípicas. A imunohistoquímica foi positiva para antígeno prostático específico (APE) e outros marcadores-chave, sendo conclusiva para carcinomatose meníngea por adenocarcinoma de próstata.

Discussão Clinicamente, esses pacientes apresentam-se com cefaleia, déficit motor, vômitos, alterações do nível de consciência e convulsões.

Os dois mecanismos mais prováveis de infiltração neoplásica são a rota hematogênica e a drenagem retrógrada pelo plexo venoso vertebral.

Conclusão Várias apresentações clínicas podem ocorrer em metástases durais; no entanto, mimetizar hematoma subdural é fato raro. Existem poucas descrições de casos como este na literatura.

Para dar apoio ao diagnóstico, o histórico médico prévio, bem como os exames complementares e os achados radiológicos são importantes porque os sintomas são comuns na emergência neurológica. Pelo que sabemos, este é o primeiro relato de neoplasia de próstata mimetizando hematoma subdural crônico no Brasil.

Keywords

subdural hematoma - metastasis - adenocarcinoma - prostate

Palavras-chave

hematoma subdural - metástase - adenocarcinoma - próstata


Publikationsverlauf

Eingereicht: 21. Februar 2020

Angenommen: 22. April 2020

Artikel online veröffentlicht:
29. März 2021

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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