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Chemarthi VS, Guron G, Shaaban H. A Unique Case of a Patient With Pancreatic Cancer Developing Leptomeningeal Metastases While on Gemcitabine and Nab-Paclitaxel. Cureus 2024; 16:e58139. [PMID: 38738113 PMCID: PMC11088938 DOI: 10.7759/cureus.58139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Brain metastases and leptomeningeal disease are rare with pancreatic cancer. Leptomeningeal disease is a catastrophic complication to have as patients deteriorate rapidly. Patients can present with symptoms of cranial nerve neuropathies, headache, nausea, and focal neurological deficits. We present a patient with metastatic pancreatic cancer who was treated initially with FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) which resulted in marked clinical and radiologic improvement. However, he started to develop severe peripheral neuropathy and was switched to maintenance gemcitabine and nab-paclitaxel. On this regimen, his systemic disease was well controlled but he developed leptomeningeal carcinomatosis. To our knowledge, this is the first case of leptomeningeal metastases developing in a patient with pancreatic adenocarcinoma while on treatment with gemcitabine and nab-paclitaxel after cessation of FOLFIRINOX. We should maintain high clinical suspicion for leptomeningeal disease in pancreatic cancer, especially when systemic disease is well controlled, as the chemotherapeutic agents may not be crossing the blood-brain barrier effectively contributing to high morbidity and mortality.
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Affiliation(s)
| | - Gunwant Guron
- Hematology and Oncology, Saint Michael's Medical Center/New York Medical College, Newark, USA
| | - Hamid Shaaban
- Hematology and Oncology, Saint Michael's Medical Center/New York Medical College, Newark, USA
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2
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Leptomeningeal Carcinomatosis in a Patient with Pancreatic Cancer: A Rare Phenomenon? MEDICINES 2022; 9:medicines9070039. [PMID: 35877817 PMCID: PMC9317958 DOI: 10.3390/medicines9070039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Complication of leptomeningeal carcinomatosis (LMC) is critical. It causes rapid neurological deterioration, and subsequently, discontinuation of the ineffective treatment even in body tumor dormancy. Large molecular chemotherapeutic agents that are unlikely to penetrate the CSF space, are more likely to not treat LMC, typically in chemo-sensitive tumors. With the introduction of novel regimens, significant advances in overall survival have been observed even in formerly chemo-resistant tumors, such as pancreatic cancer. Although such cases are still rare, the number of pancreatic cancer patients complicated with LMC are increasing, and this therefore needs more recognition. A 49-year-old woman was diagnosed with stage IVa pancreatic cancer. She underwent surgery, and subsequent adjuvant chemotherapy. After three lines of chemotherapy over a 3-year period, where the body disease remained dormant, the patient was complicated by LMC. The diagnosis was made 4 months after the onset of headache. The patient received intrathecal methotrexate treatment but succumbed shortly after treatment induction. Pancreatic cancer is still relatively chemo-resistant and is one of the least likely types of tumor to be complicated by LMC due to patients dying of the primary tumor. Advancements in treatments have led to a prolonged period of primary tumor control, but not in the CNS due to the poor penetration of chemo-agents to this site. The present case seems to be a typical result of modern era anti-cancer therapy. Therefore, we emphasize the necessity of earlier recognition of this complication so that we can initiate specific treatment targeting the CSF space, especially in this formerly chemo-resistant tumor in order to improve its prognosis.
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Umana GE, Tomasi SO, Palmisciano P, Scalia G, Da Ros V, Al-Schameri R, Priola SM, Brunasso L, Giammalva GR, Paolini F, Costanzo R, Bonosi L, Gerardi RM, Maugeri R, Strigari L, Stieg PE, Esposito G, Lawton MT, Griessenauer CJ, Winkler PA. Intracranial Venous Alteration in Patients With Aneurysmal Subarachnoid Hemorrhage: Protocol for the Prospective and Observational SAH Multicenter Study (SMS). Front Surg 2022; 9:847429. [PMID: 35449549 PMCID: PMC9018107 DOI: 10.3389/fsurg.2022.847429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundArterial vasospasm has been ascribed as the responsible etiology of delayed cerebral infarction in patients with aneurysmal subarachnoid hemorrhage (aSAH), but other neurovascular structures may be involved. We present the protocol for a multicenter, prospective, observational study focused on analyzing morphological changes in cerebral veins of patients with aSAH.Methods and AnalysisIn a retrospective arm, we will collect head arterial and venous CT angiograms (CTA) of 50 patients with aSAH and 50 matching healthy controls at days 0–2 and 7–10, comparing morphological venous changes. A multicenter prospective observational study will follow. Patients aged ≥18 years of any gender with aSAH will be enrolled at 9 participating centers based on the predetermined eligibility criteria. A sample size of 52 aSAH patients is expected, and 52 healthy controls matched per age, gender, and comorbidities will be identified. For each patient, sequential CTA will be conducted upon admission (day 0–2), at 7–10 days, and at 14–21 days after aSAH, evaluating volumes and morphology of the cerebral deep veins and main cortical veins. One specialized image collecting center will analyze all anonymized CTA scans, performing volumetric calculation of targeted veins. Morphological venous changes over time will be evaluated using the Dice coefficient and the Jaccard index and scored using the Boeckh–Behrens system. Morphological venous changes will be correlated to clinical outcomes and compared between patients with aSAH and healthy-controls, and among groups based on surgical/endovascular treatments for aSAH.Ethics and DisseminationThis protocol has been approved by the ethics committee and institutional review board of Ethikkommission, SALK, Salzburg, Austria, and will be approved at all participating sites. The study will comply with the Declaration of Helsinki. Written informed consent will be obtained from all enrolled patients or their legal tutors. We will present our findings at academic conferences and peer-reviewed journals.Approved Protocol Version and RegistrationVersion 2, 09 June 2021.
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Affiliation(s)
- Giuseppe E. Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
- *Correspondence: Giuseppe E. Umana
| | - S. Ottavio Tomasi
- Department of Neurological Surgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
- Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Salzburg, Austria
| | - Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital of National Importance “Garibaldi”, Catania, Italy
| | - Valerio Da Ros
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Rahman Al-Schameri
- Department of Neurological Surgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Stefano M. Priola
- Division of Neurosurgery Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Lara Brunasso
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Giuseppe Roberto Giammalva
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Federica Paolini
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Roberta Costanzo
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Lapo Bonosi
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Rosa Maria Gerardi
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Rosario Maugeri
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Philip E. Stieg
- Department of Neurosurgery, Weill Cornell Medicine, New York, NY, United States
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael T. Lawton
- Departments of Neurosurgery and Neurobiology, Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Christoph J. Griessenauer
- Department of Neurological Surgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
- Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Salzburg, Austria
| | - Peter A. Winkler
- Department of Neurological Surgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
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Alshoabi SA, Almas KM, Aldofri SA, Hamid AM, Alhazmi FH, Alsharif WM, Abdulaal OM, Qurashi AA, Aloufi KM, Alsultan KD, Omer AM, Daqqaq TS. The Diagnostic Deceiver: Radiological Pictorial Review of Tuberculosis. Diagnostics (Basel) 2022; 12:diagnostics12020306. [PMID: 35204395 PMCID: PMC8870832 DOI: 10.3390/diagnostics12020306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
Tuberculosis (TB) is a bacterial infection with Mycobacterium tuberculosis; it is a public health problem worldwide and one of the leading causes of mortality. Since December 2019, the COVID-19 pandemic has created unprecedented health challenges and disrupted the TB health services, especially in high-burden countries with ever-increasing prevalence. Extrapulmonary and even pulmonary TB are an important cause of nonspecific clinical and radiological manifestations and can masquerade as any benign or malignant medical case, thus causing disastrous conditions and diagnostic dilemmas. Clinical manifestations and routine laboratory tests have limitations in directing physicians to diagnose TB. Medical-imaging examinations play an essential role in detecting tissue abnormalities and early suspecting diagnosis of TB in different organs. Radiologists and physicians should be familiar with and aware of the radiological manifestations of TB to contribute to the early suspicion and diagnosis of TB. The purpose of this article is to illustrate the common radiologic patterns of pulmonary and extrapulmonary TB. This article will be beneficial for radiologists, medical students, chest physicians, and infectious-disease doctors who are interested in the diagnosis of TB.
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Affiliation(s)
- Sultan Abdulwadoud Alshoabi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
- Correspondence:
| | - Khaled M. Almas
- Radiology Department, Al-Hawbany Hospital, Alhodeidah, Yemen;
| | - Saif A. Aldofri
- Radiology Department, Central Military Hospital, Sana’a, Yemen;
| | | | - Fahad H. Alhazmi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Walaa M. Alsharif
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Osamah M. Abdulaal
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Abdulaziz A. Qurashi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Khalid M. Aloufi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Kamal D. Alsultan
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Awatif M. Omer
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia; (F.H.A.); (W.M.A.); (O.M.A.); (A.A.Q.); (K.M.A.); (K.D.A.); (A.M.O.)
| | - Tareef S. Daqqaq
- Radiology Department, Faculty of Medicine, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia;
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Iwatsuka K, Kikuta D, Shibuya H, Ogawa M, Gotoda T, Moriyama M, Nakagawara H, Hemmi A, Yamao K. Treatment Outcome of Nab-paclitaxel Plus Gemcitabine for Leptomeningeal Carcinomatosis from Pancreatic Ductal Adenocarcinoma: An Autopsy Case Report. Intern Med 2021; 60:3743-3748. [PMID: 34148945 PMCID: PMC8710377 DOI: 10.2169/internalmedicine.4456-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A 57-year-old woman with a sudden-onset seizure was hospitalized. Brain magnetic resonance imaging findings led to a suspicion of leptomeningeal carcinomatosis (LMC) without a brain parenchymal tumor, and abdominal computed tomography showed a tumor in the pancreatic tail. Endoscopic ultrasonography-guided fine needle aspiration of the pancreatic mass revealed adenocarcinoma. Therefore, LMC from pancreatic ductal adenocarcinoma was strongly suspected. She received three courses of nab-paclitaxel plus gemcitabine and whole-brain radiation. Shortly thereafter, she developed a severe consciousness impediment and died. A pathological autopsy showed adenocarcinoma in a wide area of the leptomeninges.
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Affiliation(s)
- Kunio Iwatsuka
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Japan
| | - Daiichiro Kikuta
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Japan
| | - Hitoshi Shibuya
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Japan
| | - Masahiro Ogawa
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Japan
| | - Mitsuhiko Moriyama
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine Graduate School of Medicine, Japan
| | | | - Akihiro Hemmi
- Division of Pathology, Nihon University School of Medicine Graduate School of Medicine, Japan
| | - Kenji Yamao
- Department of Gastroenterology, Narita Memorial Hospital, Japan
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Assaf I, Mans L, Sakr R, Verset G, Van Laethem JL. Unusual metastasis in BRCA mutated pancreatic cancer while on maintenance Olaparib: Two case reports and review of the literature. Eur J Cancer 2021; 157:63-67. [PMID: 34487986 DOI: 10.1016/j.ejca.2021.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 12/12/2022]
Abstract
The most common metastatic sites of pancreatic cancer are the liver, lymph nodes, peritoneum and lung. Here we report two cases of BRCA mutated pancreatic cancer that developed unusual metastasis while treatment with maintenance Olaparib and leading to rapid death. We hereby review the literature and address the possibility of a different nature and tumour biology of BRCA mutated cancer treated with PARP inhibitors.
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Affiliation(s)
- Irene Assaf
- Departement of Medical Oncolgy, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | - Laura Mans
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Rita Sakr
- Departement of Pathology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Gontran Verset
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean L Van Laethem
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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7
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Ceccon G, Wollring M, Brunn A, Deckert M, Waldschmidt D, Fink GR, Galldiks N. Leptomeningeal Carcinomatosis in a Patient with Pancreatic Cancer Responding to Nab-Paclitaxel plus Gemcitabine. Case Rep Oncol 2020; 13:35-42. [PMID: 32095126 PMCID: PMC7011711 DOI: 10.1159/000504697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022] Open
Abstract
Leptomeningeal carcinomatosis is an extremely rare, but devastating complication in pancreatic cancer patients with a poor prognosis despite multimodal treatment. We present a 51-year-old male patient with the very rare condition of leptomeningeal carcinomatosis originating from pancreatic cancer. He presented to our hospital with severe headache and neck stiffness 30 months after systemic chemotherapy. Cerebral and spinal MRI as well as cerebrospinal fluid examination confirmed the diagnosis of leptomeningeal carcinomatosis. The patient responded to gemcitabine plus nab-paclitaxel in terms of elimination of tumor cells from the CSF and concurrent clinical improvement for 3 months. The observed findings suggest that the combination of gemcitabine plus nab-paclitaxel is potentially effective in affected cerebrospinal fluid of pancreatic carcinoma patients.
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Affiliation(s)
- Garry Ceccon
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Wollring
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Brunn
- Department of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martina Deckert
- Department of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dirk Waldschmidt
- Department of Hepato- and Gastroenterology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany.,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany
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8
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Primary Diffuse Leptomeningeal Melanomatosis: Case Report and Review of the Literature. World Neurosurg 2018; 122:648-655. [PMID: 30496931 DOI: 10.1016/j.wneu.2018.11.163] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary diffuse leptomeningeal melanomatosis (PDLM) is an extremely rare pathologic condition that can mimic several other neurologic disease states. METHODS We report a rare case of PDLM without evidence of a primary focus. In addition, we performed a comprehensive review of the literature to describe all previously reported cases of PDLM. RESULTS In the reported case, making the diagnosis of PDLM was difficult. A brain and frontal dural biopsy was nondiagnostic. Computed tomography of the chest, abdomen, and pelvis did not show any distinct solitary mass. After a positron emission tomography scan was performed that showed lumbar sacral enhancement, lumbar dorsal rootlet biopsy was initiated, which was diagnostic of PDLM. Our literature review found 32 previously reported cases of PDLM. Sixteen cases (48.5%) had a distinct focus or mass discovered on imaging workup. The reported case was the seventeenth reported case of PDLM without a distinct focus or mass found on imaging workup. CONCLUSIONS PDLM is an extremely rare disease, and diagnosis is difficult because of nonspecific clinical, radiographic, and laboratory findings. In approximately half of cases, no distinct mass is shown on imaging workup, which may further complicate diagnosis. PDLM should be on the differential diagnosis for cases of diffuse dural enhancement. Neurosurgical intervention is often limited to ventriculoperitoneal shunting for increased intracranial pressure and dural and cranial biopsy to obtain diagnosis. If the initial biopsy is nondiagnostic, hypermetabolic activity as seen on positron emission tomography may be helpful to find an alternative biopsy site.
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9
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Jordan EJ, Lowery MA, Basturk O, Allen PJ, Yu KH, Tabar V, Beal K, Reidy DL, Yamada Y, Janjigian Y, Abou-Alfa GK, O'Reilly EM. Brain Metastases in Pancreatic Ductal Adenocarcinoma: Assessment of Molecular Genotype-Phenotype Features-An Entity With an Increasing Incidence? Clin Colorectal Cancer 2018; 17:e315-e321. [PMID: 29496399 PMCID: PMC6759921 DOI: 10.1016/j.clcc.2018.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/21/2018] [Accepted: 01/31/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To assess clinical characteristics of patients with metastatic pancreas ductal adenocarcinoma (PDAC) and brain metastases (BM), and to assess somatic and germ-line molecular profiles where performed. PATIENTS AND METHODS Patients with PDAC and BM between January 1990 and January 2016 were identified. Molecular characteristics of somatic and germ-line testing where performed in the subset of patients who had provided informed consent. Somatic alterations were assessed by either MSK-IMPACT testing (>340 key cancer genes) or Sequenom testing (8-gene panel). Overall survival was calculated from date of diagnosis to either date of last follow-up or death. Survival after BM was calculated from date of diagnosis of BM by radiology or pathology to either date of last follow-up or death. RESULTS From a total of 5824 patients with PDAC identified from January 2000 to January 2016, twenty-five patients (0.4%) had BM. Median age at PDAC diagnosis was 58 years. Median time to the development of BM from initial PDAC diagnosis was 17 months (range, 0-79 months). Median overall survival after BM diagnosis was 1.5 months (range, 1-31 months). Overall survival for patients who had craniotomy (n = 4) was 11 months (range, 1-31 months), with 2 long-term survivors at 21 and 31 months, respectively. Four patients had leptomeningeal disease. Six of 25 patients had germ-line testing, and 3 had BRCA mutations (2 BRCA1 and 1 BRCA2). Somatic profiling identified KRAS mutations in 100% (4 G12D, 2 G12V, and 1 Q61K). CONCLUSION BM from PDAC is a rare event. We identified a speculative association of germ-line BRCA1/2 alterations with BM in PDAC, which requires corroboration. Survival after BM development is poor; prolonged survival occurred in selected patients via a multidisciplinary approach.
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Affiliation(s)
- Emmet J Jordan
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maeve A Lowery
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Olca Basturk
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter J Allen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth H Yu
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kathryn Beal
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Diane L Reidy
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yelena Janjigian
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ghassan K Abou-Alfa
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Eileen M O'Reilly
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY.
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