Symptomatic Meckel's Cave Metastasis from Castration-resistant Prostate Cancer Treated with Gamma Knife Radiosurgery

Renal Cell Carcinoma Metastasis to Meckel's Cave Treated With Repeat Stereotactic Radiosurgery: A Case Report and Review of the Literature

Renal cell carcinoma (RCC) metastases to Meckel's cave (MC) are a rare condition. To the best of our knowledge, we present the first case of an RCC metastasis to MC successfully treated on two consecutive occasions with stereotactic radiosurgery (SRS). A 57-year-old man presented with new-onset facial pain and numbness. Magnetic resonance imaging (MRI) revealed a lesion invading MC. He was treated with Gamma Knife SRS successfully, resulting in both symptomatic improvement and radiologic tumour regression. Thirteen months after treatment, he presented with a recurrence of trigeminal nerve symptoms. He was treated with hypofractionated SRS successfully, with a follow-up MRI revealing resolution of the disease. While RCC metastases to MC are a rare phenomenon, published literature to date recommends surgical resection in combination with radiotherapy and systemic therapy. Metastatic disease to MC has only been treated once before with radiosurgery alone. Our case demonstrates that repeat SRS is feasible and efficacious. This approach may be favourable in patients wishing to avoid risks of surgical resection, or for those with unresectable disease. Metastases of RCC to MC are a rare occurrence and typically present with facial pain and/or hypoesthesia. This case demonstrates that repeat radiosurgery may be an effective alternative to surgical resection.

Cranial nerve palsy caused by metastasis to the skull base in patients with castration-resistant prostate cancer: Three case reports

INTRODUCTION

Skull base metastasis of prostate cancer associated with cranial nerve palsy is rare. We observed three patients with aggressive prostate cancer who experienced cranial nerve palsy.

CASE PRESENTATION

Case 1 was a 53-year-old patient who was treated with carboplatin and etoposide. He noticed sensory abnormalities on his left mouth edge. Head magnetic resonance imaging revealed skull base metastasis. Case 2 was a 50-year-old patient who received docetaxel. This patient exhibited ptosis of the left eye. Skull base metastasis was detected by magnetic resonance imaging. External beam radiation therapy was performed. Case 3 was a 64-year-old patient who was treated with docetaxel. He experienced ptosis of the right eye and diplopia. He was also treated with external beam radiation therapy.

CONCLUSION

External beam radiation therapy exhibited some efficacy against the symptoms, but skull base metastasis of treatment-resistant prostate cancer has poor prognosis. Three patients died within 3 months after symptoms occurred with or without external beam radiation therapy.

Metastatic epithelial ovarian cancer to Meckel's cave with leptomeningeal spread at time of diagnosis

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Rare case of aggressive epithelial ovarian cancer with brain metastasis at time of initial diagnosis.

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First reported case of epithelial ovarian cancer with invasion of Meckel’s cave.

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Increasing numbers of ovarian cancer with brain metastasis in uncommon sites of recurrence.

Background

Brain metastasis occurs in 1–2.5% of epithelial ovarian cancer (EOC) cases and carries a poor prognosis. Typically, brain metastases arise 2–3 years following the primary diagnosis of EOC. Malignant spread to the brain discovered at the time of initial ovarian cancer presentation is exceedingly rare with minimal reported cases in literature.

Case

This is a rare case of highly aggressive EOC in a previously healthy 32-year-old woman with evidence of brain, bone, and vertebral metastasis at the time of initial diagnosis. This is the first reported case of EOC with spread to Meckel’s cave with symptoms consistent with trigeminal nerve disruption. The disease rapidly progressed through radiation and front-line chemotherapy.

Conclusion

This report highlights the first reported case of EOC with invasion of Meckel’s cave—present at time of diagnosis. Consistent with most cases in the literature of brain metastasis in the setting of EOC, our patient had a highly aggressive tumor associated with a poor prognosis. With better primary management of EOC, along with increased overall survival in EOC patients following spread to the brain secondary to multimodal therapies, we can continue to expect increasing numbers of brain metastasis with uncommon sites of recurrence.