Tumor-to-Tumor Metastasis of Prostatic Adenocarcinoma in Transitional Meningioma: A Case Report and Literature Review

Abstract

Benign and malignant tumors can be receivers of tumors from other sites. Intracranial prostate metastasis is a rare phenomenon. Implantation of prostate metastasis in a meningioma is an exceptional condition. The article presents a case of metastasis of prostatic adenocarcinoma implanted in a transitional meningioma of the left frontal convexity, in which the patient began with neurological symptoms and had no previous diagnosis of prostate neoplasia.

 

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Resumo

Tumores benignos e malignos podem ser receptores de implantes de tumores de outros locais. A metástase intracraniana do câncer de próstata é um fenômeno raro. A implantação de metástase de adenocarcinoma de próstata em um meningioma é uma condição excepcional. O artigo apresenta um caso de metástase de adenocarcinoma prostático implantado em um meningioma transicional de convexidade frontal à esquerda, no qual o paciente iniciou com sintomas neurológicos e não tinha diagnóstico prévio de neoplasia prostática.

 

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Keywords

tumor-to-tumor - meningioma - adenocarcinoma - prostate

Palavras-chave

tumor a tumor - meningioma - adenocarcinoma - próstata

Introduction

Metastasis is the most frequent tumors of the central nervous system. Prostatic adenocarcinoma is the most common cancer in men and frequently metastasizes, mainly to bones and lymph nodes. Few cases of metastasis of prostatic adenocarcinoma in the intracranial compartment are reported in the literature. Meningiomas are the most common primary brain tumors. Brain metastasis and meningiomas are common. However, metastases implanted in meningiomas ('tumor-to-tumor') are extremely rare. This article aims to present a case of a 65-year-old male patient with a radiological diagnosis of an expansive extra-axial frontal lesion on the left, who presented with mental confusion. The anatomopathological and immunohistochemical findings showed prostatic adenocarcinoma metastases in a transitional meningioma. Therefore, the patient was investigated and the presence of multimetastatic prostate neoplasm was defined.

 

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Case Report

A 65-year-old male patient, previously with arterial hypertension, began to experience progressive confusion two weeks before admission. On physical examination, the patient appeared in good general condition, alert, confused (disoriented in time and space), and without language impairment. Strength and sensitivity are preserved. No meningeal signs. The investigation began with a non-contrast computed tomography (CT) scan of the brain, which showed an expansile left frontal lesion that was isodense to the parenchyma, with adjacent vasogenic edema, causing a 10 mm shift of the midline to the right and v encephalomalacia on the right, suggestive of a previous ischemic lesion ([Fig. 1]).

Fig. 1 Non-contrast cranial CT in axial sections showing expansile frontal lesion on the left with perilesional vasogenic edema resulting in midline shift to the right and temporoparietal gliotic area on the right.

The investigation continued with magnetic resonance imaging (MRI) of the brain, which showed a large expansile extra-axial frontal lesion on the left, measuring 5.1 × 5.4 × 5.3 cm, with intense gadolinium enhancement and extensive adjacent vasogenic edema. On T2 and FLAIR, the lesion presents predominantly with hypersignal, with areas of hyposignal within. The lesion results in compression of the frontal horn of the left lateral ventricle. The MRI findings suggest convexity meningioma ([Fig. 2]).

Fig. 2 Figur: MRI, axial sections, A-C, flair-weighted, showing expansive lesion in the left frontal pole, heterogeneous, with adjacent vasogenic edema. Temporoparietal gliosis on the right (previous ischemic stroke). D-F, T2-weighted, showing cerebrospinal fluid rim adjacent to the expansive frontal lesion, defining an extra-axial lesion. G-I, T1-weighted with contrast, showing intense gadolinium enhancement.

Neurosurgery was indicated, and total macroscopic resection of the lesion was performed with meningeal resection adjacent to the lesion (Simpson I). The patient progressed satisfactorily in the postoperative period, with no new deficits and improved mental confusion. A postoperative control CT scan of the skull was performed, with no evidence of neurosurgical complications ([Fig. 3]).

Fig. 3 Postoperative CT of the skull and axial sections, showing complete resection of the expansile lesion. No evidence of neurosurgical complications.

The anatomopathological examination revealed whitish and infiltrative areas in a grayish-white, shiny lesion, sometimes lobulated, sometimes fasciculated. These findings suggest adenocarcinoma metastasis in transitional meningioma. Immunohistochemistry confirmed the findings, defining prostatic adenocarcinoma in transitional meningioma ([Fig. 4]).

Fig. 4 A: Meningioma without atypia with fascicular architectural pattern. B: Meningioma without atypia and meningothelial pattern. C: Acinar pattern adenocarcinoma involving meningioma. (Hematoxylin-eosin, 100x). D: Adenocarcinoma revealing positive immunoexpression for NKX3. E: Adenocarcinoma revealing positive immunoexpression for CK7. F: Meningioma revealing positive immunoexpression for EMA. (100X).

Considering the anatomopathological results, the investigation continued with oncological screening and staging exams. CT scans of the chest, abdomen, and pelvis showed that bone structures were extensively affected by small bone lesions with a predominantly osteoblastic appearance ([Fig. 5]). Presence of lymph node enlargement in bilateral iliac chains, more exuberant in external iliac chains measuring up to 3.6 × 3.4 cm on the left and 2.6 × 2.4 cm on the right. Prominent lymph nodes in the lumbar retroperitoneum, measuring up to 1.4 × 1.0 cm in the para-aortic chain. Prostate antigens corroborated the immunohistochemistry findings: Free PSA: 47.7 ng/ml and total PSA: 1333 ng/ml. Thus, the diagnosis of metastatic prostatic adenocarcinoma was confirmed.

Fig. 5 CT scan of the chest, abdomen, and pelvis, sagittal section, bone window, showing multiple diffuse osteoblastic lesions in the spine and sternum (arrows).

Patients with adequate post-operative neurological rehabilitation followed up for oncological treatment.

 

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Discussion

Metastases are the most common tumors in the central nervous system and can be found in different compartments, including brain parenchyma, meninges, cranial vault, and ventricular system. The most common primary symptoms are lung, breast, skin (melanoma), and kidney cancers. Prostatic adenocarcinoma is the most common cancer in men and frequently metastasizes, mainly to the bones and lymph nodes. The spread of metastasis of prostatic adenocarcinoma to the intracranial compartment is rare and varies from 0.2 to 0.63% in published series.[1] [2] [3] [4] [5]

Meningiomas are the most common primary brain tumors. They originate in the arachnoid and may be either extraaxial or, less frequently, intraventricular. The most found topographies are parasagittal, convexity, falx cerebri, and olfactory groove.

Brain metastases and meningiomas are common. However, metastases implanted in meningiomas are extremely rare, with approximately 149 cases currently described in the literature.[1] Documented cases of metastases in meningiomas include the most common primary cancer topography: breast, lung, skin (melanoma), kidney, gastrointestinal, and prostate, with the first two being the most frequent. The literature shows 10 cases of prostatic adenocarcinoma metastases in meningioma ([Table 1]).[3] [4] [6] [7] [8] [9] [10] [11] [12]

Table 1 Published cases of patients with prostate cancer metastases in meningiomas

Patient	Age	Meningioma topography	Meningioma histology	Reference
1	70	Right parietal convexity	Meningothelial	[3]
2	75	Left cerebellopontine angle	Meningothelial	[6]
3	78	Falcine	Meningothelial	[7]
4	55	Parasagittal	Meningothelial	[4]
5	67	No data	No data	[8]
6	72	Falcine	Atypical	[9]
7	67	Olfactory groove	Meningothelial	[10]
8	58	Right frontal convexity	No data	[11]
9	57	Parasagittal	No data	[11]
10	68	Left sphenoid wing	Transitional	[12]
Current	65	Left frontal convexity	Transitional	Current

Several factors make meningiomas the most common intracranial tumors that receive metastases, including more incident primary intracranial tumors, slow growth rate, hypervascularity, and high collagen and lipid content. Furthermore, it is believed that cell adhesion molecules and specific receptors in meningiomas may facilitate the colonization of metastatic cells.[1] [12]

The incidence of tumor metastasis is not well defined. However, it is probably underdiagnosed. Clinical studies and published case reports highlight the importance of considering this hypothesis in patients with meningiomas, with anatomopathological analysis of the entire lesion being essential.[1]

 

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Conclusion

Tumor-to-tumor metastases in intracranial neoplasms are rare. Still, they indicate the occurrence of coexisting systemic cancer, often not yet diagnosed. Therefore, it is essential to conduct a thorough histopathological study. Given the low incidence of this condition, there is a lack of data in the literature that would help to better elucidate the conditions of presentation, diagnosis, and management of these diseases. Despite these facts, it is important to continue with the already-known treatment of meningioma and the usual oncological management of metastatic cancer.

 

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Conflict of Interest

None.

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Publication History

Received: 03 November 2024

Accepted: 20 March 2025

Article published online:
16 July 2025