Trigeminal Cave Brain Metastasis from Prostate Adenocarcinoma: Case Report and Review of the Literature

Abstract

The present study presents the case of a 66-year-old patient diagnosed with prostate adenocarcinoma 4 years earlier and treated with prostatectomy, radiotherapy, chemotherapy and hormone therapy but still displaying high prostate-specific antigen (PSA) levels. The patient complaints were double vision and headaches. Upon physical examination, he displayed 6th cranial nerve paresis and 5th cranial nerve paresthesia. A magnetic resonance imaging (MRI) exam was performed, which revealed a mass on the right trigeminal cave. The patient underwent surgical removal of the tumor, and the pathological analysis of the specimen established metastatic prostate cancer as the diagnosis.

Brain metastases from prostate cancer are extremely rare and mark advanced disease, with immune system failure and blood-brain barrier breach. Prostate-specific antigen levels do not correlate with the possibility of metastatic disease. Prostate adenocarcinoma is the histologic type most commonly associated with brain metastases, with the meninges being more frequently affected, followed by the brain parenchyma. The neurological symptoms more often displayed are non-focal, such as headaches and mental confusion. Surgery associated with radiotherapy is the most validated treatment.

Resumo

O presente estudo apresenta o caso de um paciente de 66 anos, há 4 anos diagnosticado com adenocarcinoma de próstata e tratado com prostatectomia, radioterapia, quimioterapia e hormonioterapia, porém mantendo elevados níveis de antígeno específico de próstata (PSA, na sigla em inglês). Inicialmente, o paciente se queixou de diplopia e cefaléia. Ao exame físico, apresentava paresia do 6° nervo craniano e parestesia do 5° nervo craniano. Foi realizada uma ressonância magnética, em que foi observado um tumor no cavo trigeminal do lado direito. O paciente foi submetido a uma neurocirurgia e a análise anatomopatológia evidenciou carcinoma prostático metastático.

As metástases cerebrais de câncer de próstata são extremamente raras e indicam doença avançada, com falha do sistema imune e da barreia hematoencefálica. O valor de PSA não está relacionado com a ocorrência de metástases. O tipo histológico mais comum às metástases cerebrais é o adenocarcinoma, e o principal sítio de acometimento são as meninges, seguidas pelo parênquima cerebral. Os sintomas neurológicos mais comuns são não focais, como cefaleia e confusão mental. O tratamento mais validado é cirurgia associada à radioterapia.

Keywords

meckel cave - metastatic prostate cancer - skull base tumor

Palavras-chave

cavo de meckel - câncer de próstata metastático - tumor de base de crânio

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