Unusual Presentation of Metastatic Disease

Introduction: Prostate carcinoma, like breast, has a tendency to metastasize to bone. Although much less common than breast, significant numbers of skull base lesions have been reported. Most of these present with diplopia, and less commonly with compressive optic neuropathy. In rare cases De-differentiation may produce a myriad of other symptoms.

Materials and Methods: Individual case report of a 65-year-old patient with a prior history of prostate cancer treated with radiation therapy who presented with a 6-month history of decreased vision that was progressive with proptosis and motility disturbance, found to be severely anemic.

Results: Review of the MRI scan shows extensive involvement in the marrow of the skull base. In addition, there was extension into the orbit producing proptosis, resistance to retropulsion, and optic neuropathy. Fine needle aspiration biopsy confirmed the presence of small blue tumor cells compatible with metastatic prostate carcinoma.

Conclusions: De-differentiation of prostate carcinoma can produce extensive bone marrow involvement, as in this case resulting in producing severe pancytopenia. In addition extension into the orbit produced optic neuropathy and restricted motility. Involvement also at the tuberculum produced evidence of chiasmal syndrome. Severe pancytopenia led to rapid demise in spite of efforts to reverse the thrombocytopenia.