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. 2024 Sep 30;8:215. doi: 10.1038/s41698-024-00713-8

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© The Author(s) 2024

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — a A timeline for the patient from diagnosis to death, with treatment and PSA levels indicated. The staining features are summarized from IHC staining in (c). Created with Biorender.com. b Brain MRI scan (T1- and T2-weighted images after gadolinium contrast) showed lobulated enhancing, expansile intraosseous lesions in the posterior left parietal bone, conglomerated in appearance and measuring ~5.1 × 1.6 cm. There is cortical destruction of the inner and outer tables of the calvarium. There is mass effect on the underlying dura with associated thickening and enhancement. Anteriorly, one of these enhancing components infiltrates the adjacent left occipital brain parenchyma (red arrow) and results in a 3.3 cm round-shaped intraparenchymal hemorrhage with surrounding vasogenic edema and mass affect. There is a second dural-based 1.2 × 1.4 cm metastatic focus (green arrow) next to left posterior temporal lobe with suspicion of adjacent brain parenchyma invasion. The cerebral ventricles are proportionate to the sulci, without midline shift. c Top H&E: Grade Group 5 acinar adenocarcinoma (black arrows) infiltrating prostate stroma and surrounding normal glands (blue arrow). Gleason pattern 4 carcinoma was also present (not shown). Middle H&E: Cribriform acinar adenocarcinoma involving the peridural connective tissue. Bottom H&E: Underlying high-grade neuroendocrine carcinoma (NEPC) with sheet-like growth pattern and high mitotic activity replacing brain parenchyma. Staining for AR, TP53, INSM1, CHGA, and PD-L1 is shown. The black arrow in TP53 for the dura adenocarcinoma is a focal area of staining suggestive of mutated pattern of TP53, as similar to TP53 in the NEPC component. The black arrow in PD-L1indicates low (5%) staining in the dural adenocarcinoma. d Genes of interest in prostate cancer with their most significant functional impact as calculated by variant effect predictor (VEP) consequences, indicated by color. e Heatmap of log2 copy ratio of dura adenocarcinoma or brain NEPC as compared to primary prostate.