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Omori M, Ogawa T, Oyama K, Tagaya H, Fukasawa H, Hirata S. Leptomeningeal metastasis from cervical cancer: Report of two cases and a review of the literature. J Obstet Gynaecol Res 2021; 47:2782-2789. [PMID: 34002430 DOI: 10.1111/jog.14825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/02/2021] [Accepted: 04/30/2021] [Indexed: 12/01/2022]
Abstract
Leptomeningeal metastases from cervical cancer are extremely rare, with only 24 cases reported in the English-language literature. Leptomeningeal metastasis (LM) is usually a late event, but it can develop at any stage. A 44-year-old woman presented with vertigo, tinnitus, diminution of hearing, and a cervical tumor at the initial visit. She underwent whole brain radiotherapy and systemic chemotherapy. Five months after the initial visit, her condition deteriorated rapidly and she died. A 49-year-old woman underwent surgery and pelvic radiotherapy for cervical cancer. She underwent resection of lung metastases 2 years later and received systemic chemotherapy for lymph node metastases 4 years later. Five years after the initial visit, the patient suddenly presented with diplopia, headache, and vomiting; her clinical course was fulminant and she died. Most patients with LM present with diverse clinical manifestations and deteriorate rapidly despite multiple treatment modalities. Gynecologic oncologists should be aware of this rare complication.
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Affiliation(s)
- Makiko Omori
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tatsuyuki Ogawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Keisuke Oyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hikaru Tagaya
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hiroko Fukasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Brain Metastases from Uterine Cervical and Endometrial Cancer. Cancers (Basel) 2021; 13:cancers13030519. [PMID: 33572880 PMCID: PMC7866278 DOI: 10.3390/cancers13030519] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary This review investigated the prevalence, clinical characteristics, clinical presentation, diagnosis, treatment, and prognosis of patients with brain metastases from uterine cervical carcinoma (CC) and uterine endometrial carcinoma (EC). The findings of this review indicate the factors that can facilitate better treatment selection and, consequently, better outcomes in patients with CC and EC. Abstract Reports on brain metastases (BMs) from uterine cervical carcinoma (CC) and uterine endometrial carcinoma (EC) have recently increased due to the development of massive databases and improvements in diagnostic procedures. This review separately investigates the prevalence, clinical characteristics, clinical presentation, diagnosis, treatment, and prognosis of BMs from CC and uterine endometrial carcinoma EC. For patients with CC, early-stage disease and poorly differentiated carcinoma lead to BMs, and elderly age, poor performance status, and multiple BMs are listed as poor prognostic factors. Advanced-stage disease and high-grade carcinoma are high-risk factors for BMs from EC, and multiple metastases and extracranial metastases, or unimodal therapies, are possibly factors indicating poor prognosis. There is no “most effective” therapy that has gained consensus for the treatment of BMs. Treatment decisions are based on clinical status, number of the metastases, tumor size, and metastases at distant organs. Surgical resection followed by adjuvant radiotherapy appears to be the best treatment approach to date. Stereotactic ablative radiation therapy has been increasingly associated with good outcomes in preserving cognitive functions. Despite treatment, patients died within 1 year after the BM diagnosis. BMs from uterine cancer remain quite rare, and the current evidence is limited; thus, further studies are needed.
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Carpenter K, Decater T, Iwanaga J, Maulucci CM, Bui CJ, Dumont AS, Tubbs RS. Revisiting the Vertebral Venous Plexus-A Comprehensive Review of the Literature. World Neurosurg 2020; 145:381-395. [PMID: 33049379 DOI: 10.1016/j.wneu.2020.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/23/2022]
Abstract
The venous drainage of the vertebral and paravertebral regions is important for a better understanding of hematogenous disease spread. Moreover, the spine surgeon must be well acquainted with this anatomy to minimize intraoperative and postoperative complications. A comprehensive review of the vertebral venous plexus (Batson plexus) was performed with a concentration on the clinical and surgical correlations of this venous network.
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Affiliation(s)
- Kennedy Carpenter
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Tess Decater
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Christopher M Maulucci
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - C J Bui
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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Straccia P, Fadda G, Pierconti F. Comparison between cytospin and liquid-based cytology in cerebrospinal fluid diagnosis of neoplastic diseases: A single institution experience. Cytopathology 2018; 30:236-240. [PMID: 30468697 DOI: 10.1111/cyt.12659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/15/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The current tools available for detecting malignant neoplasms in the cerebrospinal fluid (CSF) are neurological examination, followed by neuroimaging, cytology and molecular techniques. To highlight the role of cytology the diagnosis of metastatic tumours in CSF samples, we present our experience using cytospin and ThinPrep liquid-based cytology. METHODS A retrospective analysis was conducted using the pathological records of 8181 cytological specimens of CSF, which were diagnosed over a 17-year period. Between 2000 and 2014, a total of 6994 CSF samples were processed using cytospin method and 1187 specimens were examined using ThinPrep method in the period between 2015 and 2017. RESULTS The most frequent metastatic neoplasm of the first period was non-Hodgkin lymphoma; in the second period the commonest malignancy found was brain tumour (glioblastoma and medulloblastoma). The samples processed by cytospin revealed cytolysis and haemorrhage, while the cases processed by ThinPrep had a clear background. Ten false-positive cases belonging to the suspicious category were processed by cytospin, while there was only one false positive case in the group processed by ThinPrep. The positive predictive value was 95% in cytospin and 100% in Thin Prep with comparable sensitivity, specificity, diagnostic accuracy and negative predictive values. CONCLUSIONS CSF cytology is a reliable technique for identifying malignancy in CSF. ThinPrep technology can be applied with good results in terms of clear background, cell enrichment, better nuclear details and high cellularity per slide.
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Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pierconti
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
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Toyoshima M, Tsuji K, Shigeta S, Tokunaga H, Ito K, Watanabe Y, Yoshinaga K, Otsuki T, Niikura H, Yaegashi N. Leptomeningeal metastasis from gynecologic cancers diagnosed by brain MRI. Clin Imaging 2017; 41:42-47. [DOI: 10.1016/j.clinimag.2016.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022]
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Oike T, Ohno T, Noda SE, Murata T, Hirakawa T, Hirato J, Furuya M, Sato H, Hirota Y, Minegishi T, Nakano T. Leptomeningeal metastasis of uterine cervical cancer 17 years after primary tumor treatment. Clin Case Rep 2015; 4:54-61. [PMID: 26783437 PMCID: PMC4706399 DOI: 10.1002/ccr3.445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 09/07/2015] [Accepted: 10/14/2015] [Indexed: 11/06/2022] Open
Abstract
Leptomeningeal metastasis (LM) of uterine cervical cancer is extremely rare. A 54-year-old woman with uterine cervical cancer treated with surgery and radiotherapy developed LM manifesting as ptosis 17 years later. Although rare, LM should be considered in patients with a history of uterine cervical cancer presenting with cranial nerve symptoms.
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Affiliation(s)
- Takahiro Oike
- Department of Radiation Oncology Gunma University Graduate School of Medicine 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology Gunma University Graduate School of Medicine 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology Gunma University Graduate School of Medicine 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
| | - Tomomi Murata
- Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
| | - Takashi Hirakawa
- Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
| | - Junko Hirato
- Department of Pathology Gunma University Hospital 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
| | - Mio Furuya
- Department of Pathology Gunma University Hospital 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
| | - Hiro Sato
- Department of Radiation Oncology Gunma University Graduate School of Medicine 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
| | - Yuka Hirota
- Department of Radiation Oncology Gunma University Graduate School of Medicine 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
| | - Takashi Minegishi
- Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
| | - Takashi Nakano
- Department of Radiation Oncology Gunma University Graduate School of Medicine 3-39-22 Showa-machi Maebashi Gunma 371-8511 Japan
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Bae YS, Cheong JW, Chang WS, Kim S, Oh EJ, Kim SH. Diagnostic Accuracy of Cerebrospinal Fluid (CSF) Cytology in Metastatic Tumors: An Analysis of Consecutive CSF Samples. KOREAN JOURNAL OF PATHOLOGY 2013; 47:563-8. [PMID: 24421850 PMCID: PMC3887159 DOI: 10.4132/koreanjpathol.2013.47.6.563] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) examination can be used to verify the presence of primary malignancies as well as cases of central nervous system (CNS) metastasis. Because of its importance, there have been several studies concerning the sensitivity of CSF cytology. To determine the practical use and reproducibility of diagnoses based on CSF cytology, we evaluated this test by analyzing cytology results from consecutive CSF samples. METHODS Between July 2010 and June 2013, 385 CSF cytology samples from 42 patients were collected. The samples were gathered using a ventricular catheter and reservoir. CSF cytology of all patients was examined more than two times with immunocytochemistry for cytokeratin. RESULTS Primary neoplastic sites and histologic types of patients' metastatic cancer were diverse. The overall sensitivity for detecting malignancy was 41.3%. Even within short-term intervals, diagnoses frequently changed. CONCLUSIONS Our results were inconsistent, with low sensitivity, when compared to the results of previous studies. However, CSF evaluation can still provide valuable diagnostic and prognostic information because adjuvant treatments are now routinely performed in patients with CNS metastasis. Negative CSF cytology results should not be ignored, and continuous CSF follow-up is essential for following the clinical course of patients with metastatic cancer involving the CNS.
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Affiliation(s)
- Yoon Sung Bae
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - June-Won Cheong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Won Seok Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea. ; Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sewha Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Oh
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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Bougel S, Lhermitte B, Gallagher G, de Flaugergues JC, Janzer RC, Benhattar J. Methylation of the hTERT promoter: a novel cancer biomarker for leptomeningeal metastasis detection in cerebrospinal fluids. Clin Cancer Res 2013; 19:2216-23. [PMID: 23444211 DOI: 10.1158/1078-0432.ccr-12-1246] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The diagnosis of leptomeningeal metastases is usually confirmed by the finding of malignant cells by cytologic examination in the cerebrospinal fluid (CSF). More sensitive and specific cancer biomarkers may improve the detection of tumor cells in the CSF. Promoter methylation of the human telomerase reverse transcriptase (hTERT) gene characterizes most cancer cells. The aim of this study was to develop a sensitive method to detect hTERT methylation and to explore its use as a cancer biomarker in CSF. EXPERIMENTAL DESIGN In 77 CSF specimens from 67 patients, hTERT promoter methylation was evaluated using real-time methylation-sensitive high-resolution melting (MS-HRM) and real-time TaqMan PCR and MS-HRM in a single-tube assay. RESULTS Real-time MS-HRM assay was able to detect down to 1% hTERT-methylated DNA in a background of unmethylated DNA. PCR products were obtained from 90% (69/77) of CSF samples. No false positive hTERT was detected in the 21 non-neoplastic control cases, given to the method a specificity of 100%. The sensitivity of the real-time MS-HRM compared with the cytologic gold standard analysis was of 92% (11/12). Twenty-six CSFs from 22 patients with an hTERT-methylated primary tumor showed cytologic results suspicious for malignancy; in 17 (65%) of them, a diagnosis of leptomeningeal metastases could be confirmed by the hTERT methylation test. CONCLUSION The hTERT real-time MS-HRM approach is fast, specific, sensitive, and could therefore become a valuable tool for diagnosis of leptomeningeal metastases as an adjunct to the traditional examination of CSF.
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Affiliation(s)
- Stéphanie Bougel
- Authors' Affiliation: Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
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Francolini M, Sicurella L, Rizzuto N. Leptomeningeal carcinomatosis mimicking Creutzfeldt-Jakob disease: clinical features, laboratory tests, MRI images, EEG findings in an autopsy-proven case. Neurol Sci 2012; 34:441-4. [PMID: 22526756 PMCID: PMC3617350 DOI: 10.1007/s10072-012-1021-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 03/13/2012] [Indexed: 11/28/2022]
Abstract
Leptomeningeal carcinomatosis (LC) refers to diffuse seeding of the leptomeninges by tumor metastases. The clinical presentation may differ and the diagnosis may be difficult especially when cancer has not yet been diagnosed. We report a case of LC, where the clinical picture and a specific change in cerebrospinal fluid suggested the diagnosis of a prion disease.
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A case of primary uterine cervical neuroendocrine tumor with meningeal carcinomatosis confirmed by diagnostic imaging and autopsy. Int J Clin Oncol 2010; 16:581-6. [DOI: 10.1007/s10147-010-0155-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022]
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Devkota B, Patel H. Meningeal carcinomatosis from cervical cancer: a case report and review of the literature. Hosp Pract (1995) 2010; 38:117-21. [PMID: 20890060 DOI: 10.3810/hp.2010.06.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Meningeal carcinomatosis (MC) from cervical cancer is rare. Diagnosis of this disease is often delayed due to variable presentation. We report an interesting case of MC from the uterine cervix and review general diagnostic and treatment considerations. The patient received chemotherapy and radiotherapy for stage IIB cervical cancer with resolution of symptoms for 3 years. Metastatic lesions were found in the right lung and paraaotic nodes on follow-up positron emission tomography scan, which completely resolved with subsequent chemotherapy. Unfortunately, the patient developed neurological symptoms consistent with MC, which was confirmed by cerebrospinal fluid cytology. Because of her poor cognition, available options were discussed with her family. She died peacefully in palliative care.
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Yamauchi N, Sameshima H, Osato K, Fukushima K, Sato Y, Ikenoue T. Carcinomatous meningitis from adenocarcinoma of the uterine cervix: A case report and literature review. J Obstet Gynaecol Res 2010; 36:444-7. [DOI: 10.1111/j.1447-0756.2009.01163.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Asensio N, Luis A, Costa I, Oliveira J, Vaz F. Meningeal carcinomatosis and uterine carcinoma: three different clinical settings and review of the literature. Int J Gynecol Cancer 2009; 19:168-72. [PMID: 19258961 DOI: 10.1111/igc.0b013e31819a1e1a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Leptomeningeal carcinomatosis is a rare metastatic event in gynecological neoplasias, and most cases occur in ovarian cancer. It is extremely infrequent in cervical cancer, and so far, there are not any reports of this complication in association with endometrial cancer. PATIENTS AND METHODS We report a case of leptomeningeal carcinomatosis secondary to endometrial carcinoma and 2 complex cervix cancer cases. A MEDLINE search was done to review all published cases of this complication in gynecological cancer to identify predictive factors for this diagnosis. RESULTS AND DISCUSSION Leptomeningeal carcinomatosis is usually diagnosed late in the course of the disease, and most reports concern ovarian cancer patients. The number of cases describing this neurologic complication in cervix cancer is increasing. Gadolinium-enhanced magnetic resonance imaging may be necessary for this diagnosis, because cerebrospinal fluid analysis results may be negative. Most cervix cases had squamous cell (8/14) or neuroendocrine histologic subtype (3/14), and when reported, differentiation was usually poor. The case we report of endometrial carcinoma, unique in the literature, is a serous adenocarcinoma. CONCLUSIONS A high index of suspicion is necessary, and leptomeningeal carcinomatosis should be considered in patients with unexplained neurologic symptoms whose gynecologic tumors are poorly undifferentiated or have a serous component.
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Affiliation(s)
- Nuria Asensio
- Medical Oncology; and daggerNeurology Departments, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
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Kizawa M, Mori N, Hashizume Y, Yoshida M. Pathological examination of spinal lesions in meningeal carcinomatosis. Neuropathology 2008; 28:295-302. [DOI: 10.1111/j.1440-1789.2007.00879.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ignatius RT, Wills SM, Nadeau L, Deperalta-Venturina M, Weiner S. Leptomeningeal carcinomatosis due to squamous cell carcinoma of the uterine cervix associated with HPV-45. J Clin Oncol 2008; 26:154-6. [PMID: 18165650 DOI: 10.1200/jco.2007.14.3180] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Renjitha T Ignatius
- Department of Internal Medicine, Division of Hematology/Oncology, William Beaumont Hospital, Royal Oak, MI, USA
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Han L, Bhan R, Johnson S, Zak I, Husain M, Al-Abbadi MA. Leptomeningeal metastasis in a patient with squamous cell carcinoma of the uterine cervix: Report of a case and review of the literature. Diagn Cytopathol 2007; 35:660-2. [PMID: 17854087 DOI: 10.1002/dc.20705] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Leptomeningeal spread of advanced squamous cell carcinoma (SCC) of the uterine cervix is unusual. To our knowledge, very few cases were reported in the English literature. We report a case of a 39-yr-old woman who presented with leptomeningeal metastasis from a stage IIb SCC of uterine cervix. The diagnosis was made by cytomorphological examination of smears obtained from cerebrospinal fluid. The cytomorphological features are demonstrated.
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Affiliation(s)
- Liying Han
- Department of Pathology, Wayne State University and Karmanos Cancer Institute, Detroit, Michigan 48201, USA
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Portera CC, Gottesman RF, Srodon M, Asrari F, Dillon M, Armstrong DK. Optic neuropathy from metastatic squamous cell carcinoma of the cervix: An unusual CNS presentation. Gynecol Oncol 2006; 102:121-3. [PMID: 16507318 DOI: 10.1016/j.ygyno.2006.01.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 01/04/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Central nervous system (CNS) metastases from cervical carcinoma are uncommon events. Leptomeningeal involvement from cervical squamous cell carcinoma has not been extensively described. CASE A 43-year-old woman with initial diagnosis of stage IB squamous cervical carcinoma at age 30 was treated with hysterectomy and left salpingo-oophorectomy. She recurred with nodal disease at age 39 and went into a clinical complete remission after chemotherapy and radiation treatment. Three years later, she presented with symptoms of optic neuropathy. Cerebral spinal fluid (CSF) was positive for squamous cells consistent with primary cervical squamous cell carcinoma. No measurable disease was evident outside of the CNS. CONCLUSION Meningeal carcinomatosis from cervical squamous cell carcinoma involving optic nerves has not been reported. Rapid progression of this patient's CNS metastatic disease suggests this form of metastases may be more aggressive and carry extremely poor prognosis.
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Affiliation(s)
- Chia Chiao Portera
- Department of Internal Medicine, Sinai Hospital of Baltimore, MD 21215, USA
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Kastritis E, Moulopoulos LA, Politi E, Kostis E, Pissakas G, Dimopoulos MA, Bamias A. Intramedullary spinal cord and leptomeningeal metastases in a patient with carcinoma of the uterine cervix. Gynecol Oncol 2006; 102:124-7. [PMID: 16494929 DOI: 10.1016/j.ygyno.2006.01.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 01/04/2006] [Accepted: 01/12/2006] [Indexed: 10/25/2022]
Abstract
BACKGROUND : Neoplastic meningitis in patients with carcinoma of the uterine cervix is unusual in the course of their diseases. Even more unusual are intramedullary spinal metastases. CASE We report the case of a 64-year-old woman who presented with leptomeningeal and intramedullary spinal cord metastases from a grade 2 squamous cell cancer of the uterine cervix. This is just the second case of intramedullary metastases from cervical carcinoma. CONCLUSION Neoplastic meningitis or intramedullary metastases are extremely rare in the course of uterine cervix carcinoma. Nevertheless, when indicated by symptoms, patients should undergo MRI of the brain and/or spine and have a lumbar puncture performed, for the diagnosis of this devastating complication. Treatment is mainly palliative but may offer symptom relief.
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Affiliation(s)
- E Kastritis
- Department of Clinical Therapeutics, Alexandra Hospital, Athens University School of Medicine, 31 Komninon St, Haidari, 124 62 Athens, Greece
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Abstract
Leptomeningeal metastases (LM) are increasingly recognized as a devastating complication of solid tumors. Improved treatment of primary malignancy and advances in diagnostic imaging have led to an apparent increase in the number of patients diagnosed with LM. Unfortunately, therapeutic options remain limited. Radiotherapy is used to treat bulky tumor and provide symptomatic relief. Intrathecal chemotherapy benefits a selected subset of patients. The challenge to the future is to delineate the molecular mechanisms underlying LM and to develop novel therapeutic or prophylactic modalities to combat LM.
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Pavlidis N. The diagnostic and therapeutic management of leptomeningeal carcinomatosis. Ann Oncol 2005; 15 Suppl 4:iv285-91. [PMID: 15477323 DOI: 10.1093/annonc/mdh941] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Pavlidis
- School of Medicine, University of Ioannina, Greece
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Rentinck MEM, Schrijver HM, Kneppers E, Zijlmans JCM, van Groeningen CJ. Carcinomatous meningitis in cancer of the uterine cervix. J Neurooncol 2004; 70:87-90. [PMID: 15527113 DOI: 10.1023/b:neon.0000040836.20884.fc] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Carcinomatous meningitis is extremely rare in cervical cancer. The diagnosis of carcinomatous meningitis is a difficult one when clinical symptoms are limited and radiographic imaging is normal. Demonstration of malignant cells in the cerebrospinal fluid remains the gold standard to establish the diagnosis. For patients without bulky disease who can be treated with radiotherapy, standard treatment for carcinomatous meningitis is chemotherapy, which may be administered intrathecally. Despite the poor prognosis, treatment may result in effective palliation. We describe a 54-year-old patient who was diagnosed with carcinomatous meningitis in the course of metastatic cervical cancer and who responded to administration of intrathecal methotrexate.
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Affiliation(s)
- M E M Rentinck
- Department of Medical Oncology, VU Medical Center, Amsterdam, The Netherlands
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Wuntkal R, Maheshwari A, Kerkar RA, Kane SV, Tongaonkar HB. Carcinoma of uterine cervix primarily presenting as carcinomatous meningitis: a case report. Aust N Z J Obstet Gynaecol 2004; 44:268-9. [PMID: 15191458 DOI: 10.1111/j.1479-828x.2004.00209.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rekha Wuntkal
- Department of Genitourinary and Gynecology Oncology, Tata Memorial Hospital, Mumbai, India.
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Mahajan A, Borden J, Tsai JS. Carcinomatous meningitis: are surgery or gamma knife radiosurgery treatment risk factors? J Neurosurg 2002. [DOI: 10.3171/jns.2002.97.supplement_5.0441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. The purpose of this study was to identify possible risk factors leading to carcinomatous meningitis in patients with a known brain metastasis and who were treated with gamma knife radiosurgery (GKS).
Methods. Two hundred eighty lesions in 101 patients were treated during 121 GKS procedures. The clinical and neuroimaging history, tumor histology, and follow-up studies were reviewed for all patients. Evidence as demonstrated by magnetic resonance imaging criteria and/or cerebrospinal fluid (CSF) cytology of carcinomatous meningitis was evaluated. The data were then analyzed to identify potential risk factors for the development of CSF dissemination.
Conclusions. It appears that carcinomatous meningitis is exclusively identified in patients with adenocarcinoma, in particular with primary lung cancer. Furthermore, the incidence is higher if surgery is performed and the interval to subsequent GKS is prolonged.
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Chang AK. Diplopia in a patient with carcinomatous meningitis: a case report and review of the literature. J Emerg Med 2002; 23:351-4. [PMID: 12480013 DOI: 10.1016/s0736-4679(02)00566-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a patient with a history of malignancy, an isolated neurologic sign or symptom may indicate metastasis to the central nervous system. To exclude this possibility, a lumbar puncture should still be performed after a nondiagnostic cranial computed tomography (CT) scan even in the absence of signs of infection. A case is presented of a 59 year-old man recently diagnosed with non-Hodgkin's lymphoma that presented to the Emergency Department (ED) with the sole complaint of diplopia. Examination was unremarkable except for a left abducens nerve palsy. Cranial CT scan was normal but initial cerebrospinal fluid results were suggestive of carcinomatous meningitis, and cytology results later confirmed this diagnosis. A review of diplopia and carcinomatous meningitis is presented, along with a suggested conservative diagnostic algorithm for cancer patients presenting with neurologic signs or symptoms.
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Affiliation(s)
- Andrew K Chang
- Department of Emergency Medicine, University of California, Irvine Medical Center, Orange, California 92868, USA
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Affiliation(s)
- S A Jeyapalan
- Neurological Institute, Columbia-Presbyterian Medical Center, New York, New York, USA
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