1
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Dye A, Stein R, Lewis G, Hew K. Leptomeningeal Carcinomatosis From Primary Mucinous Carcinoma of the Ovary. Cureus 2024; 16:e51556. [PMID: 38313981 PMCID: PMC10835194 DOI: 10.7759/cureus.51556] [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: 12/31/2023] [Indexed: 02/06/2024] Open
Abstract
Leptomeningeal carcinomatosis (LMC) is an extremely rare site for metastasis from a primary ovarian cancer. LMC occurs when the thin layers of tissue that surround the brain and spinal cord are infiltrated by ovarian cancer metastasis. We present a case of a 63-year-old female with recurrent metastatic mucinous adenocarcinoma of the ovary who was diagnosed with LMC. While undergoing sixth-line chemotherapy, she presented with debilitating headaches and gait instability. Brain MRI revealed subarachnoid enhancement and other findings diagnostic of LMC. Given the rarity of this disease, treatment protocols have yet to be established. In patients with primary ovarian cancer that present with new onset neurological complaints, LMC should be suspected and appropriate imaging obtained.
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Affiliation(s)
- Alexander Dye
- Obstetrics and Gynecology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Rachel Stein
- Radiology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Gregory Lewis
- Obstetrics and Gynecology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Karina Hew
- Gynecologic Oncology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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2
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Takahara K, Katayama M, Tamura R. Prolonged Survival and Restored Useful Life by Early Induction of Intrathecal Chemotherapy in a Patient with Leptomeningeal Carcinomatosis from Ovarian Cancer. Brain Sci 2022; 12:748. [PMID: 35741633 PMCID: PMC9221092 DOI: 10.3390/brainsci12060748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/09/2022] [Accepted: 06/04/2022] [Indexed: 11/17/2022] Open
Abstract
Leptomeningeal carcinomatosis (LMC) is a rare but devastating complication of advanced cancer. Breast cancer, lung cancer, and melanoma are the three most common causes of LMC, whereas it is rare in ovarian cancer. Here, we report the case of a 59-year-old woman who was diagnosed with LMC from ovarian cancer and was successfully treated with intrathecal chemotherapy via Ommaya reservoir and radiation therapy. The patient had an amelioration of symptoms and prolonged survival. Though LMC from ovarian cancer is thought to be rare, it is not going to remain a rare entity because the incidence of LMC in general is thought to be increasing, which is also the case with ovarian cancer. According to 31 cases whose treatment course is reported in literature, despite the absence of an established treatment for LMC, intrathecal (IT) chemotherapy whose survival benefit has been suggested in past studies might also prolong survival in patients with LMC from ovarian cancer. IT chemotherapy via Ommaya reservoir may be preferred to the lumbar puncture route. The presentation of non-specific symptoms of LMC in patients may hinder its diagnosis; however, early diagnosis and treatment induction is the key for patients' prolonged survival and restored useful life.
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Affiliation(s)
- Kento Takahara
- Department of Neurosurgery, Kawasaki Municipal Hospital, Kawasaki 210-0013, Japan; (K.T.); (M.K.)
| | - Makoto Katayama
- Department of Neurosurgery, Kawasaki Municipal Hospital, Kawasaki 210-0013, Japan; (K.T.); (M.K.)
| | - Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, Tokyo 160-8582, Japan
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3
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Stopa BM, Cuoco JA, Adhikari S, Grider DJ, Rogers CM, Marvin EA. Iatrogenic Leptomeningeal Carcinomatosis Following Craniotomy for Resection of Metastatic Serous Ovarian Carcinoma: A Systematic Literature Review and Case Report. Front Surg 2022; 9:850050. [PMID: 35548192 PMCID: PMC9082594 DOI: 10.3389/fsurg.2022.850050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Metastasis of ovarian carcinoma to the central nervous system occurs in <2% of cases and classically localizes within the brain parenchyma. Moreover, leptomeningeal spread of these tumors is an exceedingly rare phenomenon. Here, we conduct a systematic review of the current literature on the natural history, treatment options, and proposed pathogenic mechanisms of leptomeningeal carcinomatosis in ovarian carcinoma. We also report a case of a 67-year-old female with stage IV metastatic ovarian serous carcinoma initially confined to the peritoneal cavity with a stable disease burden over the course of three years. Follow-up imaging demonstrated an intracranial lesion, which was resected via craniotomy, and pathology was consistent with the original diagnosis. Three months after surgery, she developed rapidly progressive dizziness, generalized weakness, fatigue, and ataxia. Repeat MRI demonstrated interval development of extensive and diffusely enhancing dural nodularity, numerous avidly enhancing supratentorial and infratentorial lesions, enhancement of the bilateral trigeminal nerves, internal auditory canals, and exit wound from the surgical site into the posterior aspect of the right-sided neck musculature consistent with diffuse leptomeningeal dissemination. The present case highlights that leptomeningeal dissemination of ovarian carcinoma is a potential yet rare consequence following surgical resection of an ovarian parenchymal metastasis. Progressive clinical symptomatology that develops postoperatively in this patient population should prompt urgent workup to rule out leptomeningeal disease and an expedited radiation oncology consultation if identified.
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Affiliation(s)
- Brittany M. Stopa
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
| | - Joshua A. Cuoco
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Srijan Adhikari
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Douglas J. Grider
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- Dominion Pathology Associates, Roanoke, VA, United States
| | - Cara M. Rogers
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Eric A. Marvin
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- Section of Neurosurgery, Carilion Clinic, Roanoke, VA, United States
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
- *Correspondence: Eric A. Marvin
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4
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Kataoka M, Kondo H, Hirano Y. Resection of solitary abdominal wall metastasis of ascending colon cancer along the ventriculoperitoneal shunt: A case report. Int J Surg Case Rep 2021; 82:105869. [PMID: 33857764 PMCID: PMC8065276 DOI: 10.1016/j.ijscr.2021.105869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/03/2021] [Accepted: 04/04/2021] [Indexed: 11/28/2022] Open
Abstract
Colorectal cancer could metastasize to the VP shunt, although it is rare. Careful intraoperative manipulation would prevent metastasis to the VP shunt. Resection may be effective for VP shunt-related skin metastases.
Introduction Ventriculoperitoneal (VP) shunt is often placed as a treatment for hydrocephalus. Additionally, it is also not uncommon to perform laparoscopic surgery for colon cancer with a VP shunt in place. It is very rare for colorectal cancer to metastasize to an implanted VP shunt. We report a case of VP shunt-related metastasis of the ascending colon that was successfully resected. Presentation of case A 79-year-old man who had a VP shunt for hydrocephalus two years earlier underwent laparoscopic right colectomy for ascending colon cancer. Six months after the colectomy, imaging examinations showed mass formation in the subcutaneous tissue of the abdominal wall along the VP shunt. Because of the possible metastasis of colorectal cancer and the fact that it was a solitary lesion, a tumor resection with replacement of the VP shunt was performed. Histopathological examination revealed that the mass was a metastasis of colon cancer. Discussion This case involves the metastasis of colorectal cancer in the subcutaneous tissue of the abdominal wall after laparoscopic surgery, and since the tumor had reached the serosa, the possibility of metastasis by pneumoperitoneum was considered. Careful intraoperative manipulation is considered to be important for prevention. Conclusion Metastasis of colorectal cancer to the VP shunt is extremely rare, but possible. In such cases, intraoperative prevention and careful postoperative follow-up are required.
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Affiliation(s)
- Masahiro Kataoka
- Saitama Medical University International Medical Center, Department of Gastroenterological Surgery, 1397-1 Yamane, Hidaka, Saitama, Japan.
| | - Hiroka Kondo
- Saitama Medical University International Medical Center, Department of Gastroenterological Surgery, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Yasumitsu Hirano
- Saitama Medical University International Medical Center, Department of Gastroenterological Surgery, 1397-1 Yamane, Hidaka, Saitama, Japan
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5
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Frantzias J, Polyzoidis S, Rajagopal S, Bullock P. Spreading of struma ovarii tumour via a lumbo-peritoneal shunt: first case report and short review of the literature. Br J Neurosurg 2019; 34:658-660. [PMID: 31631700 DOI: 10.1080/02688697.2019.1679353] [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: 10/25/2022]
Abstract
Neurosurgical shunts occasionally act as a conduit for seeding of central nervous system tumours to the abdomen. Retrograde spread of extra-neural tumours to the central nervous system is exceedingly rare. We report the first case of an abdominal primary tumour spreading to the spinal cord via a lumbo-peritoneal shunt. This is also the first case report of a struma ovarii tumour metastasis to the central nervous system via any route.
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Affiliation(s)
- Joseph Frantzias
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Stavros Polyzoidis
- Department of Neurosurgery, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Shobha Rajagopal
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Peter Bullock
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
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6
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Fiani B, Quadri SA, Farooqui M, D'Apuzzo M, Rosser RJ, Berman BW, Noel J, Xin XS, Badie B, Ramachandran A, Siddiqi J. A brainstem mass of Müllerian type Epithelial Origin without any primary cancer source. J Clin Neurosci 2018; 59:325-332. [PMID: 30337125 DOI: 10.1016/j.jocn.2018.10.016] [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: 04/28/2018] [Accepted: 10/04/2018] [Indexed: 11/16/2022]
Abstract
Brainstem tumors are rare, even rarer is a brainstem tumor containing tissues of an embryologic gynecologic origin. We report a very rare case of presence of a calcified heterogeneously contrast enhancing brainstem mass of Müllerian origin in a patient in a 38 year old female with no female genital tract cancer and past surgical history of ventriculoperitoneal (VP) shunt placement for congenital hydrocephalus. To our knowledge this is the very first and unusual case of a mass of gynecologic origin in the brainstem region especially in the setting of no history of gynecological tumor. The authors also reviewed the literature for all tumors reported for anterograde and retrograde dissemination of tumor cells through VP shunt. This case is a reaffirmation of the importance of brain tumor location and tissue diagnosis for the purpose of adjuvant treatment of neurosurgical lesions in the neurocritical care setting. It also highlights the role of catheters as potential routes of iatrogenic transmission not just in anterograde but also in a retrograde manner to the CNS, which is very unusual. This is the only second case to report retrograde flow of tumor cells from an extraneural source up the VP catheters. The authors suggest that intraperitoneal chemotherapy should be considered in the cases of known extraneural abdominal malignancies of high malignant potential with or without the presence of peritoneal infiltration in order to avoid dissemination through VP shunts.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Syed A Quadri
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA.
| | - Mudassir Farooqui
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Massimo D'Apuzzo
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Robert J Rosser
- Department of Pathology, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Blake W Berman
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Jerry Noel
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Xin S Xin
- Division of Neurosurgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Behnam Badie
- Division of Neurosurgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Anirudh Ramachandran
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
| | - Javed Siddiqi
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
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7
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Takatu CM, Tinoco LJ, Ferreira FR, de Oliveira RJ, Sanders FH, Sotto MN, Nico MMS. Gallbladder adenocarcinoma diagnosed from cutaneous metastases occurring along the tract of a ventriculoperitoneal shunt. J Cutan Pathol 2018; 45:870-873. [DOI: 10.1111/cup.13330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/29/2018] [Accepted: 07/24/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Luisa J. Tinoco
- Department of Dermatology; University of São Paulo; São Paulo Brazil
| | | | | | - Felipe H. Sanders
- Department of Neurosurgery; University of São Paulo; São Paulo Brazil
| | - Mírian N. Sotto
- Department of Pathology; University of São Paulo; São Paulo Brazil
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8
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Roux A, Botella C, Still M, Zanello M, Dhermain F, Metellus P, Pallud J. Posterior Fossa Metastasis-Associated Obstructive Hydrocephalus in Adult Patients: Literature Review and Practical Considerations from the Neuro-Oncology Club of the French Society of Neurosurgery. World Neurosurg 2018; 117:271-279. [PMID: 29935321 DOI: 10.1016/j.wneu.2018.06.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is no consensus concerning the management of adult patients with posterior fossa metastasis-associated obstructive hydrocephalus, especially regarding surgical procedures. A literature review was performed to assess the surgical strategy in the management of patients with metastatic brain tumor. METHODS A literature search was conducted of PubMed in November 2017 to identify all studies concerning brain metastases and obstructive hydrocephalus in English. All studies (except case reports and pediatric studies) between December 1953 and November 2017 that were about posterior fossa metastasis-associated obstructive hydrocephalus in adult patients were eligible. Eligible studies were classified by level of evidence. We assessed epidemiology, clinical and imaging findings, neurosurgical management, and prognosis of adult patients with posterior fossa metastasis-associated obstructive hydrocephalus. We suggest some practical considerations and a management decision tree on behalf of the Neuro-oncology Club of the French Society of Neurosurgery, with evidence-based analysis. RESULTS Direct surgical resection could be considered for patients with asymptomatic obstructive hydrocephalus, and endoscopic third ventriculostomy seems to be a reasonable procedure for patients with symptomatic obstructive hydrocephalus. A ventriculoperitoneal or atrial shunt seems to be a valid alternative when patients have a history of central nervous system infection or ventricular hemorrhage, leptomeningeal carcinomatosis, or unfavorable anatomy for an endoscopic third ventriculostomy to be performed. CONCLUSIONS The Neuro-oncology Club of the French Society of Neurosurgery suggests a prospective assessment of these neurosurgical procedures to compare their safety and efficacy.
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Affiliation(s)
- Alexandre Roux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Céline Botella
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Neurosurgery, Henri-Mondor Hospital, Créteil, France
| | - Megan Still
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Frédéric Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Philippe Metellus
- Department of Neurosurgery, Clairval Private Hospital, Ramsay-Générale de Santé, Marseille, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France.
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9
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Jun Jie NG, Teo KA, Shabbir A, Yeo TT. Widespread Intra-abdominal Carcinomatosis from a Rhabdoid Meningioma after Placement of a Ventriculoperitoneal Shunt: A Case Report and Review of the Literature. Asian J Neurosurg 2018; 13:176-183. [PMID: 29492156 PMCID: PMC5820881 DOI: 10.4103/1793-5482.181128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intra-abdominal metastasis (IAM) of central nervous system (CNS) tumors via ventriculoperitoneal shunt (VPS) is rare but has been previously reported (e.g., germinomas and medulloblastomas). However, there has been no previous report in the literature involving meningiomas. A case of primary rhabdoid meningioma with widespread intra-abdominal carcinomatosis after placement of a VPS in a 36-year-old man is described. The patient underwent preoperative angioembolization of the tumor, craniotomy, and surgical excision, followed by postoperative gamma knife radiosurgery. Five months later, he underwent a decompressive craniectomy and surgical excision for tumor recurrence causing raised intracranial pressure and communicating hydrocephalus, necessitating placement of a VPS. One month after placement of the VPS, the patient developed abdominal distension and confusion. He was treated for a VPS infection, and the shunt was explanted. He continued to deteriorate with high output from the peritoneal drain placed at the time of shunt explantation. An exploratory laparotomy revealed multiple diffuse peritoneal and omental nodules which had the same histopathological and immunohistochemical morphology as the primary tumor. We reviewed the current literature on IAM of primary CNS tumors via VPS, which revealed that patients belonging in the pediatric age group, of the male gender, and with a primary intracranial germinoma or medulloblastoma have a higher incidence of IAM. Majority of IAM occurred within 2 years of VPS placement, and patients most commonly present with abdominal distension and ascites. Treatment after diagnosis is varied and the prognosis is poor, with more than half of the patients dying within a year. It is vital for clinicians to maintain a high index of suspicion for similar patients, as early intervention could potentially improve patient outcomes and patient expectations managed more effectively.
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Affiliation(s)
- N G Jun Jie
- Department of General Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Kok Ann Teo
- Department of Neurosurgery, University Surgical Cluster, National University Health System, Singapore
| | - Asim Shabbir
- Department of General Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, University Surgical Cluster, National University Health System, Singapore
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10
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Zhou ZN, Canon C, Matrai C, Chapman-Davis E. Cauda equina syndrome secondary to leptomeningeal metastases from recurrent primary peritoneal carcinoma. Ecancermedicalscience 2018. [PMID: 29515655 PMCID: PMC5834310 DOI: 10.3332/ecancer.2018.814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The patient is a 42-year-old woman with metastatic primary peritoneal carcinoma and known brain metastases, who subsequently developed cauda equina syndrome after presenting with ataxia, lower extremity weakness, and bowel and bladder incontinence secondary to leptomeningeal metastasis after treatment with neoadjuvant chemotherapy, surgical debulking, and adjuvant chemotherapy. Metastases to the central nervous system (CNS) and leptomeninges are rare events in epithelial ovarian and primary peritoneal carcinomas as these tumours do not have a predilection for the CNS. Cauda equina syndrome is often characterised by gait disturbances, bowel and bladder dysfunction, saddle anaesthesia, and lower extremity muscle weakness. In patients with known metastatic gynaecologic carcinomas presenting with nonspecific neurologic symptoms, cauda equina syndrome should remain high in the differential diagnosis.
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Affiliation(s)
- Zhen Ni Zhou
- Department of Obstetrics and Gynecology, Weill Cornell Medical College--New York Presbyterian Hospital, New York, NY 10065, USA
| | - Chelsea Canon
- Department of Obstetrics and Gynecology, Weill Cornell Medical College--New York Presbyterian Hospital, New York, NY 10065, USA
| | - Cathleen Matrai
- Department of Pathology, Weill Cornell Medical College--New York Presbyterian Hospital, New York, NY 10065, USA
| | - Eloise Chapman-Davis
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Weill Cornell Medical College--New York Presbyterian Hospital, New York, NY 10065, USA
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11
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Ng JJ, Teo KA, Shabbir A, Yeo TT. Widespread Intra-abdominal Carcinomatosis from a Rhabdoid Meningioma after Placement of a Ventriculoperitoneal Shunt: A Case Report and Review of the Literature. Asian J Neurosurg 2018; 13:386-393. [PMID: 29682040 PMCID: PMC5898111 DOI: 10.4103/ajns.ajns_42_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Intra-abdominal metastasis (IAM) of central nervous system (CNS) tumors through ventriculoperitoneal shunt (VPS) is rare but has been previously reported (e.g., germinomas and medulloblastomas). However, there has been no previous reports in literature involving meningiomas. A case of primary rhabdoid meningioma with widespread intra-abdominal carcinomatosis after placement of a VPS in a 36-year-old man is described. The patient underwent preoperative angioembolization of the tumor, craniotomy, and surgical excision, followed by postoperative gamma knife radiosurgery. Five months later, he underwent a decompressive craniectomy and surgical excision for tumor recurrence causing raised intracranial pressure and communicating hydrocephalus, necessitating placement of a VPS. One month after placement of the VPS, the patient developed abdominal distension and confusion. He was treated for a VPS infection and the shunt was explanted. He continued to deteriorate with high output from the peritoneal drain placed at the time of shunt explantation. An exploratory laparotomy revealed multiple diffuse peritoneal and omental nodules which had the same histopathological and immunohistochemical morphology as the primary tumor. We reviewed the current literature on IAM of primary CNS tumors through VPS, which revealed that patients belonging to the pediatric age group of the male gender and with a primary intracranial germinoma or medulloblastoma have a higher incidence of IAM. The majority of IAM occurred within 2 years of VPS placement, and patients most commonly present with abdominal distension and ascites. Treatment after diagnosis is varied, and the prognosis is poor, with more than half of the patients dying within a year. It is vital for clinicians to maintain a high index of suspicion for similar patients as early intervention could potentially improve patient outcomes and patient expectations managed more effectively.
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Affiliation(s)
- Jun Jie Ng
- Department of General Surgery, University Surgical Cluster, National University Hospital, Singapore
| | - Kok Ann Teo
- Department of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Asim Shabbir
- Department of General Surgery, University Surgical Cluster, National University Hospital, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
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12
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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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13
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Inserra A, Narciso A, Paolantonio G, Messina R, Crocoli A. Palliative care and pediatric surgical oncology. Semin Pediatr Surg 2016; 25:323-332. [PMID: 27955737 DOI: 10.1053/j.sempedsurg.2016.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Survival rate for childhood cancer has increased in recent years, reaching as high as 70% in developed countries compared with 54% for all cancers diagnosed in the 1980s. In the remaining 30%, progression or metastatic disease leads to death and in this framework palliative care has an outstanding role though not well settled in all its facets. In this landscape, surgery has a supportive actor role integrated with other welfare aspects from which are not severable. The definition of surgical palliation has moved from the ancient definition of noncurative surgery to a group of practices performed not to cure but to alleviate an organ dysfunction offering the best quality of life possible in all the aspects of life (pain, dysfunctions, caregivers, psychosocial, etc.). To emphasize this aspect a more modern definition has been introduced: palliative therapy in whose context is comprised not only the care assistance but also the plans of care since the onset of illness, teaching the matter to surgeons in training and share paths. Literature is very poor regarding surgical aspects specifically dedicated and all researches (PubMed, Google Scholar, and Cochrane) with various meshing terms result in a more oncologic and psychosocial effort.
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Affiliation(s)
- Alessandro Inserra
- General Pediatric and Thoracic Surgery, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy.
| | - Alessandra Narciso
- General Pediatric and Thoracic Surgery, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
| | - Guglielmo Paolantonio
- Interventional Radiology Unit, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
| | - Raffaella Messina
- Neurosurgery Unit, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
| | - Alessandro Crocoli
- General Pediatric and Thoracic Surgery, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
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14
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Nigim F, Critchlow JF, Kasper EM. Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases. Mol Clin Oncol 2015; 3:1381-1386. [PMID: 26807251 DOI: 10.3892/mco.2015.627] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/12/2015] [Indexed: 11/05/2022] Open
Abstract
Approximately 1-5% of patients with cerebral metastasis and ~40% of patients with primary brain tumors suffer from hydrocephalus. These patients often exhibit a poor prognosis. The aim of the present study was to reassess the validity of ventriculoperitoneal shunting (VPS) with the assistance of the general surgeon in oncological patients. A total of 59 patients underwent first-time VPS at the Beth Israel Deaconess Medical Center (Boston, USA) between 2004 and 2012; 40 patients had hydrocephalus from brain metastasis and 19 from primary tumors. The analyzed independent variables included demographics, body mass index, past medical history, clinical presentation, indication for surgery, Karnofsky performance status (KPS) score and surgical technique; the dependent variables were postoperative symptoms and occurrence, cause and time of shunt failure. The outcomes were analyzed with the t-test and Kaplan-Meier estimates for shunt survival. The mean age of the patients was 57.2 years and the mean operative time was 50.4 min. Symptomatic palliation was achieved in 93% of the cases; patients with severe symptoms, such as debilitating headaches, nausea and vomiting, benefited significantly from VPS. The mean follow-up time was 6.3 months; complications occurred in only 7 patients (11.8%) during follow-up: 2 in the proximal shunt (1 infection and 1 obstruction), both requiring revision, 1 infection in the distal catheter requiring shunt removal, 2 cases of intracerebral bleeding that were monitored with computed tomography scans, 1 wound infection treated with antibiotics and 1 valve complication that required temporary revision. The initial and 3-month KPS scores were 65±16.4 and 75±16.0, respectively. The mean overall shunt survival was 6.4 months (range, 1.0 day-76.0 months) from the placement of the VP shunt. At 3 months after VPS, 93.5% of the patients remained alive with functioning shunts and at 1 year 87% of the shunts were still functioning. In conclusion, VPS remains a valid option for cancer patients with low KPS, as it improves the quality of life in such patients, even in the setting of previous infection, hemorrhage, or leptomeningeal disease, since shunt patency outlasts the overall survival of nearly all patients.
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Affiliation(s)
- Fares Nigim
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Jonathan F Critchlow
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ekkehard M Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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15
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Kasliwal MK, Tan LA, O'Toole JE. Intradural tumor recurrence after resection of extradural metastasis: a rare but potential complication of intraoperative durotomy. J Neurosurg Spine 2014; 20:734-9. [DOI: 10.3171/2014.3.spine13896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal metastases are the most common of spinal neoplasms and occur predominantly in an extradural location. Their appearance in an intradural location is uncommon and is associated with a poor prognosis. Cerebrospinal fluid dissemination accounts for a significant number of intradural spinal metastases mostly manifesting as leptomeningeal carcinomatoses or drop metastases from intracranial tumors. The occurrence of local tumor dissemination intradurally following surgery for an extradural spinal metastasis has not been reported previously. The authors describe 2 cases in which local intradural and intramedullary tumor recurrences occurred following resection of extradural metastases that were complicated by unintended durotomy. To heighten clinical awareness of this unusual form of local tumor recurrence, the authors discuss the possible etiology and clinical consequences of this entity.
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16
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Extraneural metastasis of a nongerminomatous germ cell tumor of the central nervous system in a pediatric patient with a ventriculoperitoneal shunt: a case report and review of the literature. J Pediatr Hematol Oncol 2012; 34:e12-6. [PMID: 22215101 DOI: 10.1097/mph.0b013e31823dd370] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe the case of a 7-year-old white boy who presented with a mixed malignant germ cell tumor with predominant embryonal carcinoma component. The patient underwent right ventriculoperitoneal (VP) shunt placement for hydrocephalus at the time of diagnosis. He received multiagent chemotherapy followed by second-look surgery. Despite an initial response to chemotherapy, the patient had metastatic progression of disease within the craniospinal axis. He received craniospinal radiation and high-dose chemotherapy. Although, he had resolution of central nervous system (CNS) disease, follow-up off treatment revealed extra-abdominal metastases. This is a rare case to discuss abdominal metastasis of a CNS germ cell tumor in a patient with a VP shunt. The influence of VP shunt placement on treatment and management decisions of patients with CNS tumors will be discussed.
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17
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Lee MH, Lee JI. Malignant ascites after subduroperitoneal shunt in a patient with leptomeningeal metastasis. J Korean Neurosurg Soc 2011; 50:385-7. [PMID: 22200024 DOI: 10.3340/jkns.2011.50.4.385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 09/27/2011] [Accepted: 10/06/2011] [Indexed: 11/27/2022] Open
Abstract
Leptomeningeal metastasis is a devastating complication of advanced stage cancer. It is frequently accompanied by hydrocephalus and intracranial hypertension that must be treated by ventriculoperitoneal shunts. However, there are actual risks of peritoneal seeding or accumulation of malignant ascites after the cerebrospinal fluid diversion procedure, though it has not been reported. Here, we present the case of a patient with non-small cell lung cancer with leptomeningeal metastasis in whom malignant ascites developed after a subduroperitoneal shunt.
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Affiliation(s)
- Min Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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18
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Grewal J, Saria MG, Kesari S. Novel approaches to treating leptomeningeal metastases. J Neurooncol 2011; 106:225-34. [PMID: 21874597 DOI: 10.1007/s11060-011-0686-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 08/03/2011] [Indexed: 12/27/2022]
Abstract
Leptomeningeal metastasis is a devastating complication of the central nervous system in patients with late-stage solid or hematological cancers. Leptomeningeal metastasis results from the multifocal seeding of the leptomeninges by malignant cancer cells. Although central nervous system metastasis usually presents in patients with widely disseminated and progressive late-stage cancer, malignant cells may spread to the cerebrospinal fluid during earlier disease stages in particularly aggressive cancers. Treatment of leptomeningeal metastasis is largely palliative but will often provide stabilization and protection from further neurological deterioration and improve quality of life. There is a need to raise awareness of the impact of leptomeningeal metastases on cancer patients and its known and putative biological basis. Novel diagnostic approaches include identification of biomarkers that may stratify the risk for developing leptomeningeal metastasis. Current therapies can be used more effectively while waiting for advanced treatments to be developed.
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Affiliation(s)
- Jai Grewal
- Long Island Brain Tumor Center, NSPC, 600 Northern Blvd, Suite 113, Great Neck, NY 11577, USA
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19
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Schiff D, Kline C, Meltzer H, Auger J. Palliative ventriculoperitoneal shunt in a pediatric patient with recurrent metastatic medulloblastoma. J Palliat Med 2009; 12:391-3. [PMID: 19327082 DOI: 10.1089/jpm.2008.0227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The authors present a case report of a pediatric patient with recurrent metastatic medulloblastoma who demonstrated significant clinical improvement after placement of a palliative ventriculoperitoneal (VP) shunt. They also review the medical literature that supports palliative surgical management of hydrocephalus and intracranial hypertension (ICH) caused by leptomeningeal (LM) spread of malignancy. The burdens and benefits of an invasive surgical procedure must always be weighed carefully, especially at end-of-life. Yet for some patients with LM spread and ICH, VP shunting may improve their quality of life, although their prognosis remains poor.
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Affiliation(s)
- Deborah Schiff
- Department of Hematology/Oncology, Rady Children's Hospital-San Diego, San Diego, California 92123, USA.
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