Dural Metastasis of Prostatic Adenocarcinoma Mimicking Meningioma en Plaque: Case Report and Systematic Review

Dural metastasis from prostate adenocarcinoma is an uncommon manifestation of advanced disease and may closely mimic primary dural tumors such as meningioma en plaque, making diagnosis particularly challenging. We report the case of a 63-year-old man with a history of treated prostate adenocarcinoma who presented with a three-month history of headache, anorexia, significant weight loss, and progressive mental confusion. Cranial computed tomography and magnetic resonance imaging demonstrated a large right frontotemporoparietal extra-axial lesion with imaging characteristics suggestive of meningioma en plaque. The patient underwent microsurgical resection because of progressive neurological deterioration, significant mass effect, and diagnostic uncertainty. Histopathological and immunohistochemical analyses confirmed dural metastasis of prostatic adenocarcinoma. The postoperative course was complicated by venous infarction, extensive intraparenchymal hemorrhage, and refractory intracranial hypertension. To better characterize this rare presentation, we performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and MEDLINE databases were searched, and 19 studies comprising 44 patients met the inclusion criteria. This case highlights the importance of considering dural metastasis in the differential diagnosis of atypical dural-based lesions in patients with a history of prostate cancer. However, because the currently available evidence is limited predominantly to isolated case reports and small case series, conclusions regarding optimal management should be interpreted with caution, and larger multicenter studies are needed to better define the clinical characteristics and management of this rare entity.