2017 Resarch Forum

IM: C-5

Applicant & Principal Investigator: Shelly Gupta MD

Rare Presentation of Metastatic Prostate Cancer Leading to Cranial Nerve Palsies and Paranasal Sinus Masses Shelly Gupta MD, Arash Heidari MD, Edward Williams MS IV, Taylor Barrett MS III

INTRODUCTION Prostate cancer is the most common malignancy of males in the United States, and the second leading cause of cancer death. Primary metastases sites of prostate cancer are blastic bone lesions, however rarely there can be metastases to the brain and paranasal sinuses. PURPOSE Presenting a case report of prostate cancer to the paranasal sinuses and cranial nerve palsies. DISCUSSION A 51 year old Hispanic male presented to the emergency department in January 2015 due to paraspinal pain. Physical examination was significant for thoracic and lumbar spine point tenderness, and an enlarged, nodular prostate by digital rectal examination. Initial PSA levels were elevated at 73ng/mL and elevated alkaline of 927 unit/liter. He underwent prostate biopsy, consistent with adenocarcinoma of the prostate, Gleason grade 9. Due to extensive metastases, patient was started on androgen deprivation therapy. Patient showed initial clinical improvement as well as serologic improvement with normalization of PSA and alkaline phosphatase levels 6 after initiation of therapy. In July 2016 patient presented to the emergency department with worsening right facial numbness, facial asymmetry, right eye pain, right eye diplopia and decreased visual acuity. Neurological was notable for right cranial nerve III palsy with moderate to severe right ptosis, limited medial, up and downward gaze and enlarged nonreactive right pupil; right cranial nerve V palsy with decreased sensation; right cranial VII palsy; and right cranial nerve XII palsy with rippling fasiculations of the tongue. PSA was elevated at 377 ng/mL. MRI of the brain showed an enhancing right temporal lobe mass near the right sphenoid wing, multiple enhancing masses in the sphenoid, ethmoid and maxillary sinuses and an enlarged pituitary gland with associated enhancing mass. CONCLUSION Prostatic metastasis occurs in 70% of cases with bone being the most common site. However, metastases to the brain and paranasal sinuses are extremely rare. Incidence of brain metastases from prostate cancer is approximately 0.16%. Paranasal cavity metastases are usually associated with renal, breast, thyroid or prostate carcinomas. Brain and paranasal cavity involvement indicate extensive dissemination and palliative therapy is the only possible treatment option.