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Doshi K, James E. A Rare Case of Metastasis of Gastric Adenocarcinoma to the Leptomeninges. Cureus 2023; 15:e37120. [PMID: 37153327 PMCID: PMC10159219 DOI: 10.7759/cureus.37120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
Leptomeningeal carcinomatosis (LMC) is defined as the diffuse infiltration of malignant cells throughout the pia and arachnoid membrane. LMC is commonly observed in patients with leukemia, lymphoma, and breast and lung cancer. The prevalence of LMC spread in patients with primary gastric malignancy is very rare. Due to its devastating neurological complications and high mortality, it is difficult to assess the associated clinical features, treatment outcomes, and prognostic factors. Current treatment options include intra-thecal chemotherapy, radiotherapy, and supportive care with a median survival of three to four months. LMC is a rare manifestation of gastric cancer and is an extremely fatal disease. Therefore, it is difficult to distinguish LMC from other neurological etiologies. We present a unique case of an individual who presented with headaches and was found to have LMC.
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2
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Cunha R, Godinho J, Inácio M, Galriça Neto I. Palliative approach to leptomeningeal carcinomatosis in oesophagogastric junction cancer. BMJ Case Rep 2019; 12:e230114. [PMID: 31604716 PMCID: PMC6803121 DOI: 10.1136/bcr-2019-230114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2019] [Indexed: 11/04/2022] Open
Abstract
Leptomeningeal carcinomatosis (LC) is rare in solid tumours, particularly in gastrointestinal cancers. While other treatment strategies remain undefined, inclusion of palliative care is essential due to its very poor prognosis and variable manifestations. We report a case of oesophagogastric junction adenocarcinoma, previously submitted to surgery and chemotherapy, diagnosed with LC and followed in a palliative care unit. Treatment was comanaged with the oncology team and a palliative approach was decided. In this report, we review the literature and evaluate treatment options, with focus on the importance of palliative care and its potential benefits in patients diagnosed with this rare entity.
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Affiliation(s)
- Renato Cunha
- Medical Oncology Department, Hospital do Espirito Santo de Évora EPE, Évora, Portugal
| | - João Godinho
- Medical Oncology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Mariana Inácio
- Medical Oncology Department, Hospital do Espirito Santo de Évora EPE, Évora, Portugal
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3
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Kountourakis P, Papamichael D, Haralambous H, Michael M, Nakos G, Lazaridou S, Fotiou E, Vassiliou V, Andreopoulos D. Leptomeningeal metastases originated from esophagogastric junction/gastric cancer: A brief report of two cases. World J Gastrointest Oncol 2018; 10:56-61. [PMID: 29375749 PMCID: PMC5767794 DOI: 10.4251/wjgo.v10.i1.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/22/2017] [Accepted: 12/05/2017] [Indexed: 02/05/2023] Open
Abstract
Leptomeningeal carcinomatosis is a very rare manifestation in patients diagnosed with esophagogastric junction and gastric cancer. Its prognosis is ominous and therapy outcomes are disappointing. Herein, we present two patients; one initially diagnosed with gastric cancer and leptomeningeal carcinomatosis but no other evidence of metastatic disease and the other one initially diagnosed with esophagogastric junction cancer, who recurred solitary with leptomeningeal seedings several years after the initial diagnosis and treatment. Furthermore, a thorough and short review of the literature is carried out.
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Affiliation(s)
| | | | | | - Michael Michael
- Department of Cytology, General Hospital of Nicosia, Nicosia 2029, Cyprus
| | - Georgios Nakos
- Department of Pathology, General Hospital of Nicosia, Nicosia 2029, Cyprus
| | - Sylvia Lazaridou
- Department of Medical Oncology, BOC Oncology Centre, Nicosia 2006, Cyprus
| | - Eleni Fotiou
- Department of Medical Oncology, BOC Oncology Centre, Nicosia 2006, Cyprus
| | | | - Demetrios Andreopoulos
- Department of Radiology, BOC Oncology Centre, Nicosia 2006, Cyprus
- Department of Radiation Oncology, BOC Oncology Centre, Nicosia 2029, Cyprus
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4
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Liu Y. Leptomeningeal carcinomatosis from gastric cancer successfully treated by the intrathecal methotrexate plus temozolomide and simultaneous radiotherapy: Case report and literatures review. Cancer Biol Ther 2017; 18:761-764. [PMID: 28881161 PMCID: PMC5678689 DOI: 10.1080/15384047.2017.1373218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/01/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022] Open
Abstract
Leptomeningeal carcinomatosis (LMC) from gastrointestinal cancer is rare. A 56-year-old man with complaint of upper abdominal pain exhibited adenocarcinoma upon histopathologic examination of biopsy specimens. At the end of adjuvant chemotherapy, the patient was affected by hearing loss. Malignant cells were observed by cerebrospinal fluid (CSF) cytology. Therefore, the patient received intrathecal methotrexate and oral temozolomide chemotherapy and radiotherapy. The progress-free survival was approximately 11 months. To our knowledge, such cases of LMC from gastric cancer are very rare. Here, we describe the case of a patient with LMC from gastric cancer and review the literature associated with treatment. We hope that the present report may be helpful when considering how to improve treatment of LMC in gastric cancer patients and offer some tips for the adjuvant treatment modality.
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Affiliation(s)
- Yangyang Liu
- Department of Oncology, People's Hospital of Xintai City No. 27 Xinfu Road, Xintai, Shandong, China
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5
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Vergoulidou M. Leptomeningeal Carcinomatosis in Gastric Cancer: A Therapeutical Challenge. Biomark Insights 2017; 12:1177271917695237. [PMID: 28469397 PMCID: PMC5391981 DOI: 10.1177/1177271917695237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 01/23/2017] [Indexed: 12/13/2022] Open
Abstract
Leptomeningeal carcinomatosis (LC) is a rare and mainly secondary site of metastasis in solid tumors. In gastric cancer (GC), it is associated with a devastating prognosis, lacking an efficient and standardized treatment approach. We report a case of primary manifestation of LC due to metastatic GC with rapid deterioration and refractory course to conventional and intrathecal chemotherapy. We review the literature and discuss the therapeutic challenges.
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Affiliation(s)
- Maria Vergoulidou
- Division of Hematology and Oncology, First Internal Medicine Department, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
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6
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Ali S, Khan MT, Idrisov EA, Maqsood A, Asad-Ur-Rahman F, Abusaada K. Signet Cell in the Brain: A Case Report of Leptomeningeal Carcinomatosis as the Presenting Feature of Gastric Signet Cell Cancer. Cureus 2017; 9:e1085. [PMID: 28405535 PMCID: PMC5384845 DOI: 10.7759/cureus.1085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Malignant infiltration of pia and arachnoid mater, referred to as leptomeningeal carcinomatosis (LMC), is a rare complication of gastric carcinoma. The most common underlying malignancy in patients with LMC are leukemia, breast cancer, lymphoma, and lung cancer. We report a case of gastric adenocarcinoma that presented with LMC in the absence of overt gastrointestinal signs or symptoms. A 56-year-old Hispanic woman presented to the hospital with a three-week history of intermittent headaches and visual blurring. An initial brain imaging showed infarction in the distribution of right posterior inferior cerebellar artery (PICA) along with communicating hydrocephalus. She underwent ventriculoperitoneal (VP) shunt placement with improvement in her symptoms. Two months later she presented again with deterioration in her mental status. Imaging studies and cerebrospinal fluid (CSF) analysis confirmed the diagnosis of LMC. Further studies determined the primary tumor to be signet ring cell gastric adenocarcinoma. However, she did not have any preceding gastrointestinal symptoms. In light of the poor prognosis, the patient's family proceeded with comfort care measures. Our case portrays a rare presentation of gastric adenocarcinoma with LMC without other distant organ metastatic involvement. It also illustrates the occult nature of gastric carcinoma and signifies the importance of neurologic assessment of patients, with or at risk of gastric carcinoma. It also raises a theoretical concern for VP shunt as a potential conduit of malignant cells from the abdomen to the central nervous system, which may serve as an important susbtrate for future research.
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Affiliation(s)
- Saeed Ali
- Internal Medicine Residency, Florida Hospital Orlando
| | | | | | - Aadil Maqsood
- Internal Medicine Residency, Florida Hospital Orlando
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7
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Nobre-Carvalho A, Caballero-Villarraso J, Grande-Pérez P, Siles-Cadilla J, Gosálbez-Pequeño B. Cauda equina syndrome in elderly patient. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Ji JG, Chung JW, Nam SW, Choi SK, Lee DW, Kim DI, Jeon BG, Shin YJ. [A Case of Isolated Leptomeningeal Carcinomatosis from Advanced Gastric Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 68:93-8. [PMID: 27554216 DOI: 10.4166/kjg.2016.68.2.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Leptomeningeal carcinomatosis (LMC) is rare metastatic form of gastric cancer. Most cases are diagnosed in the final stage after multiple distant metastasis. An 84-year-old woman was admitted with melena, headache and vomiting. Esophagogastroduodenoscopy showed an ulceroinfiltrating lesion at the stomach (Borrmann class III), and biopsy revealed a signet ring cell carcinoma. The abdominal-pelvic CT showed no evidence of metastasis. A sudden decrease of consciousness was noted, but the brain CT showed no active lesion while the brain MRI revealed enhancement of leptomeninges. A lumbar puncture was performed and the cerebrospinal fluid study revealed malignant neoplastic cells. With family consent, no further evaluation and treatment were administered and she died six weeks after the diagnosis of gastric cancer. We report an extremely rare case of a patient who initially presented with neurologic symptoms, and was diagnosed LMC from advanced gastric cancer without any evidence of metastasis in abdomen and pelvis.
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Affiliation(s)
- Jung Geun Ji
- Gastrointestinal Center, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Joo Won Chung
- Gastrointestinal Center, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Seung Woo Nam
- Gastrointestinal Center, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Seung Kyu Choi
- Gastrointestinal Center, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Dong Won Lee
- Gastrointestinal Center, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Dae In Kim
- Gastrointestinal Center, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Byung Gwan Jeon
- Gastrointestinal Center, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yun Jae Shin
- Gastrointestinal Center, Department of Internal Medicine, National Medical Center, Seoul, Korea
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9
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Wu X, Li J, Xiao J, Yang B, Yu L, Wu X, Wan J, Xu H, Kong J. [Efficacy and Security of Intrathecal with Methotrexate in the Treatment of Meningeal Carcinomatosis]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:252-6. [PMID: 27215452 PMCID: PMC5973059 DOI: 10.3779/j.issn.1009-3419.2016.05.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
背景与目的 脑膜癌病是中枢神经系统转移瘤的一种少见类型。近年来,随着恶性肿瘤治疗疗效的提高,患者生存期延长,脑膜癌病的发病率逐年增加,目前尚缺乏有效的治疗手段。本研究旨在探讨鞘内注射甲氨蝶呤(methotrexate, MTX)治疗脑膜转移的疗效、安全性和预后。 方法 对27例脑膜转移患者的临床资料、脑脊液实验室检查进行回顾性分析,并分析鞘注化疗后的不良反应及预后。 结果 27例脑膜转移患者接受鞘注化疗后,70.4%获得临床症状缓解,但脑脊液压力和脑脊液生化改变无统计学差异。55.6%患者无不适,25.9%出现下肢麻木、轻微疼痛,无严重不可逆的不良反应发生。本组患者中位生存期4个月。 结论 鞘内注射MTX可改善脑膜癌病患者临床症状,无严重不良反应发生。
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Affiliation(s)
- Xi Wu
- General Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Junling Li
- Internal Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Jianping Xiao
- Radiotherapy Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Boyan Yang
- General Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Lei Yu
- General Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Xiaoming Wu
- General Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Jinghai Wan
- Neurosurgery Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Haiyan Xu
- General Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Jianxin Kong
- Neurosurgery Department,
Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
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10
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Ahmed M, Begum T, Omer AR, Khan IA. Leptomeningeal carcinomatosis from oesophageal cancer, presenting as meningitis. BMJ Case Rep 2016; 2016:bcr-2015-210974. [PMID: 26740266 DOI: 10.1136/bcr-2015-210974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 47-year-old woman presented with headache, neck pain, dizziness, nausea and vomiting for 4-5 days. She also had a history of weight loss and difficulty in swallowing. On physical examination, she had nuchal rigidity with a positive Kernig's sign. Cerebrospinal fluid analysis revealed mild pleocytosis but some atypical cells were also noted. Cytopathological analysis of the atypical cells showed high nuclear/cytoplasmic ratios and eccentric nuclei with prominent nucleoli, consistent with malignancy. A CT scan of the head and neck showed multiple lytic lesions involving the left calvarium, and diffuse thickening and enhancement of meninges over the left cerebral area. Extensive osteolytic lesions were also noted on the vertebral bodies, pedicles and lamina, at multiple levels of the cervical spine. An endoscopy revealed a mass at the gastro-oesophageal junction, and biopsy confirmed moderately differentiated adenocarcinoma of the oesophagus. The patient was started on chemotherapy along with radiation therapy.
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11
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Kim SJ, Kwon JT, Mun SK, Hong YH. Leptomeningeal carcinomatosis of gastric cancer misdiagnosed as vestibular schwannoma. J Korean Neurosurg Soc 2014; 56:51-4. [PMID: 25289126 PMCID: PMC4185321 DOI: 10.3340/jkns.2014.56.1.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/18/2014] [Accepted: 07/15/2014] [Indexed: 11/27/2022] Open
Abstract
Gastric cancer is one of the most common causes of cancer-related death in Asian countries, including Korea. We experienced a case of leptomeningeal carcinomatosis (LC) from gastric cancer that was originally misdiagnosed as vestibular schwannoma based on the similar radiological characteristics. To our knowledge, LC from gastric cancer is very rare. In conclusion, our experience with this case suggests that clinicians should consider the possibility of delayed leptomeningeal metastasis when treating patients with gastric cancer.
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Affiliation(s)
- Shin-Jae Kim
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong-Taik Kwon
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seog-Kyun Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young-Ho Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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12
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Esmaeilzadeh M, Majlesara A, Faridar A, Hafezi M, Hong B, Esmaeilnia-Shirvani H, Neyazi B, Mehrabi A, Nakamura M. Brain metastasis from gastrointestinal cancers: a systematic review. Int J Clin Pract 2014; 68:890-9. [PMID: 24666726 DOI: 10.1111/ijcp.12395] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Brain metastases (BM) from the gastrointestinal tract (GIT) cancers are relatively rare. Despite those advances in diagnostic and treatment options, life expectancy and quality of life in these patients are still poor. In this review, we present an overview of the studies which have been previously performed as well as a comprehensive strategy for the assessment and treatment of BM from the GIT cancers. METHOD To obtain information on brain metastases from GIT, we performed a systematic review of Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). The collected data included patient characteristics, primary tumor data and brain metastases data. RESULT In our search of the literature, we found 74 studies between 1980 and 2011, which included 2538 patients with brain metastases originated from gastrointestinal cancer. Analysis of available data showed that among 2538 patients who had brain metastases from GIT, a total of 116 patients (4.57%) had esophageal cancer, 148 patients (5.83%) had gastric cancer, 233 patients (9.18%) had liver cancer, 13 patients had pancreas cancer (0.52%) and 2028 patients (79.90%) had colorectal cancer. The total median age of the patients was 58.9 years. CONCLUSION Brain metastases have been considered the most common structural neurological complication of systemic cancer. Due to poor prognosis they influence the survival rate as well as the quality of life of the patients. The treatment of cerebral metastasis depends on the patients' situation and the decisions of the treating physicians. The early awareness of a probable metastasis from GI to the brain will have a great influence on treatment outcomes as well as the survival rate and the quality-of-life of the patients.
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Affiliation(s)
- M Esmaeilzadeh
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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13
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Kon T, Funamizu Y, Miki Y, Tomiyama M, Baba M, Kurotaki H, Wakabayashi K. An autopsy case of meningeal carcinomatosis with parenchymal invasion through the cranial and spinal nerve roots. Neuropathology 2014; 34:499-503. [PMID: 24779918 DOI: 10.1111/neup.12127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 11/28/2022]
Abstract
Meningeal carcinomatosis is a well-known complication of malignant neoplasms. We report a case of meningeal carcinomatosis of 2 months' duration in a 22-year-old man, in whom the initial symptom was gradually worsening headache. Postmortem examination revealed infiltrating adenocarcinoma of the stomach. Carcinoma cells showed diffuse spread to the subarachnoid space of the brain and spinal cord. In many places, subarachnoid tumor cells had infiltrated to the cranial and spinal nerves. Moreover, carcinoma cells in the nerve roots extended to the parenchyma of the brain and spinal cord beyond the CNS-peripheral nervous system junction. These findings suggest that cranial and spinal nerve roots can be a possible route of parenchymal invasion in meningeal carcinomatosis.
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Affiliation(s)
- Tomoya Kon
- Department of Neuropathology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan
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14
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Guo JW, Zhang XT, Chen XS, Zhang XC, Zheng GJ, Zhang BP, Cai YF. Leptomeningeal carcinomatosis as the initial manifestation of gastric adenocarcinoma: A case report. World J Gastroenterol 2014; 20:2120-2126. [PMID: 24587686 PMCID: PMC3934485 DOI: 10.3748/wjg.v20.i8.2120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/08/2014] [Indexed: 02/06/2023] Open
Abstract
Leptomeningeal involvement is usually reported as a secondary event in advanced gastric carcinoma. Leptomeningeal carcinomatosis (LMC), as the initial manifestation of asymptomatic gastric cancer, is exceedingly rare with only a few cases reported in recent years. The presenting neurologic symptoms include headache, vomiting and seizures and are usually clinically atypical. The diagnosis of LMC is made via identification of malignant cells that originate from epithelial cells in the cerebrospinal fluid by cytological examination and provides cues to track the primary tumor. Endoscopic examinations are crucial to confirm the presence of gastric cancer, and imaging studies, especially gadolinium-enhanced magnetic resonance imaging of the brain, are sometimes helpful in diagnosis. Thus far, there is no standard therapy for LMC, and despite all measures, the prognosis of the condition is extremely poor. Here, we report on the clinical features and diagnostic procedures for a patient with occult gastric cancer with Bormann type I macroscopic appearance and poor differentiation in pathology, who presented with LMC-induced neurological symptoms as the initial clinical manifestation. Additionally, we review the similar cases reported over the past years, making comparison among cases in order to provide more information for the future diagnosis.
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15
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Kim NH, Kim JH, Chin HM, Jun KH. Leptomeningeal carcinomatosis from gastric cancer: single institute retrospective analysis of 9 cases. Ann Surg Treat Res 2014; 86:16-21. [PMID: 24761402 PMCID: PMC3994606 DOI: 10.4174/astr.2014.86.1.16] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the clinical features and outcomes of 9 consecutive patients who suffered with leptomeningeal carcinomatosis (LMC) originating from gastric cancer. METHODS Between January 1995 and December 2010, we retrospectively reviewed the medical records of 9 patients with gastric LMC who had been treated at St. Vincent's Hospital, The Catholic University of Korea. RESULTS With the exception of 1 patient, the primary gastric cancer was Borrmann type III or IV, and 5 cases had poorly differentiated or signet ring cell histology. TNM stage of the primary gastric cancer was III in 6 patients. The median interval from diagnosis of the primary malignancy to the diagnosis of LMC was 9 months. Headache (6 cases), altered mental status (4 cases), and dysarthria (3 cases) were presenting symptoms of LMC. Computed tomography findings were abnormal in 4 of 7 cases, while magnetic resonance imaging revealed abnormality in 4 of 5 cases. Radiation therapy was administered to 5 patients and intrathecal chemotherapy was administered to only 1 patient. Median overall survival duration from the diagnosis of LMC was 3 months. CONCLUSION LMC originating from gastric cancer had a fatal clinical course and treatment strategies remain challenging.
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Affiliation(s)
- Nam-Hee Kim
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Ji-Hyun Kim
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Hyung-Min Chin
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Kyong-Hwa Jun
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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16
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Meningeal carcinomatosis: a metastasis from gastroesophageal junction adenocarcinoma. Case Rep Med 2013; 2013:245654. [PMID: 24454393 PMCID: PMC3880727 DOI: 10.1155/2013/245654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 11/22/2013] [Accepted: 12/09/2013] [Indexed: 02/05/2023] Open
Abstract
Gastroesophageal adenocarcinoma is a malignant type of cancer, which can metastasize to multiple organs. However, there have not been many case reports in the literature pertaining the relationship of gastroesophageal adenocarcinoma and carcinomatous meningitis. In this case, a 65-year-old African American male with a history of dysphagia was initially diagnosed with adenocarcinoma at gastroesophageal junction. The patient was treated with both chemotherapy and radiation, but chemotherapy was interrupted due to significant weight loss, anemia, and sudden onset of change in mental status. Patient was admitted to our facility for further evaluation of his neurological symptoms. The patient became more confused and delirious during hospital stay, and symptoms could not be explained by radiological studies and laboratory values. Therefore, a lumbar puncture was done to search for infectious and neoplastic causes that were not shown up on Computed Tomography scan (CT) and Magnetic Resonance Imaging scan (MRI) of the brain. The cerebrospinal fluid (CSF) cytology showed metastatic poorly differentiated adenocarcinoma. The patient's prognosis was poor because there is no specific treatment recommendation for primary gastroesophageal cancer at this stage. The patient passed away 4 weeks later under hospice care. The goal of our case report is to raise awareness of the rare metastatic possibility in advanced stage of gastroesophageal adenocarcinoma. In doing so, physicians can help educate and prepare family for unfavorable outcomes.
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17
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Emoto S, Ishigami H, Yamaguchi H, Yamashita H, Kaisaki S, Kitayama J. Frequent development of leptomeningeal carcinomatosis in patients with peritoneal dissemination of gastric cancer. Gastric Cancer 2011; 14:390-5. [PMID: 21667135 DOI: 10.1007/s10120-011-0064-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 05/17/2011] [Indexed: 02/07/2023]
Abstract
We detected 7 cases of leptomeningeal carcinomatosis in 126 patients with peritoneal dissemination of gastric cancer who received combined systemic and intraperitoneal chemotherapy. Leptomeningeal carcinomatosis was diagnosed 79-1540 days after the diagnosis of the primary gastric cancer. Patients presenting with various neurological symptoms were diagnosed by cerebrospinal fluid (CSF) cytology and radiological imaging. Irradiation to the whole brain and spine was performed in 4 patients, and provided palliation and increased survival for 1 patient. Intrathecal chemotherapy and drainage of CSF was performed in 1 patient each, but produced no significant clinical benefit in either of them. Survival after the diagnosis of leptomeningeal carcinomatosis was between 3 and 155 days. As patients with peritoneal dissemination of gastric cancer are living longer because of improved chemotherapy, clinicians must recognize the possibility of leptomeningeal carcinomatosis when patients complain of neurological symptoms.
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Affiliation(s)
- Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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18
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Tomita H, Yasui H, Boku N, Nakasu Y, Mitsuya K, Onozawa Y, Fukutomi A, Yamazaki K, Machida N, Taku K, Todaka A, Taniguchi H, Tsushima T. Leptomeningeal carcinomatosis associated with gastric cancer. Int J Clin Oncol 2011; 17:361-6. [DOI: 10.1007/s10147-011-0301-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 07/20/2011] [Indexed: 10/17/2022]
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19
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Paplomata E, Wilfong L. Signet Ring Cell Carcinoma of the Ampulla of Vater With Leptomeningeal Metastases: A Case Report. J Clin Oncol 2011; 29:e627-9. [DOI: 10.1200/jco.2011.35.2385] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Lalan Wilfong
- Texas Oncology–Texas Health Presbyterian Hospital, Dallas, TX
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20
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Modern management of rare brain metastases in adults. J Neurooncol 2011; 105:9-25. [DOI: 10.1007/s11060-011-0613-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 05/22/2011] [Indexed: 12/13/2022]
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21
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The efficacy of gamma knife radiosurgery for advanced gastric cancer with brain metastases. J Neurooncol 2010; 103:513-21. [DOI: 10.1007/s11060-010-0405-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 09/06/2010] [Indexed: 10/18/2022]
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22
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Watanabe T, Hirono H, Hasegawa K, Soga K, Shibasaki K, Yoneoka Y. Advanced gastric cancer patient with peritonitis carcinomatosa successfully treated with a combination therapy of paclitaxel and TS-1, but relapsed with multiple bone metastasis and died from rapidly progressive meningitis carcinomatosa--advanced gastric cancer with metachronous peritonitis carcinomatosa and meningitis carcinomatosa. Intern Med 2009; 48:151-6. [PMID: 19182425 DOI: 10.2169/internalmedicine.48.1319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 59-year-old man diagnosed as gastric cancer with peritonitis carcinomatosa was treated with paclitaxel and TS-1; 60 mg/m(2)/day of paclitaxel was given on days 1 and 8, and 60-80 mg/m(2)/day of TS-1 was given for 2 weeks. Six courses of combination therapy were administered, and the ascites disappeared completely. Because multiple bone metastases occurred, we attempted combination therapy with cisplatin and irinotecan hydrochloride; 50 or 30 mg/m(2)/day of cisplatin was given on day 1 or day 15, and 70 mg/m(2)/day of irinotecam hydrochloride was given on days 1 and 15. The patient achieved a remarkable response, however, intrameningeal dissemination occurred and he died from rapidly progressive meningitis carcinomatosa.
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Affiliation(s)
- Takuya Watanabe
- Department of Internal Medicine and Gastroenterology, Medical Hospital, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan.
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23
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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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24
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Abstract
Leptomeningeal carcinomatosis occurs in approximately 5% of patients with cancer. The most common cancers involving the leptomeninges are breast, lung cancer and melanoma. However, gastric adenocarcinoma has been rarely reported with leptomeningeal carcinomatosis. The presenting manifestations are usually headache, visual disturbances and seizures. We report a case of leptomeningeal metastasis that presented as a gastric cancer. A 49-year-old woman was admitted to our hospital with the symptoms of headache and melena for 10 days. The endoscopy showed a thickening of the folds of the stomach compatible with the diagnosis of a Borrman type IV gastric cancer. The biopsy revealed a signet ring cell carcinoma. The MRI of brain showed no abnormal findings; however, the patient complained of an intractable persistent headache, nausea and vomiting on admission day 6. The cytology examination of the cerebrospinal fluid supported the diagnosis of metastatic signet ring cell carcinoma.
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Affiliation(s)
- Hong Gi Lee
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, Korea.
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25
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Abstract
Advanced gastric cancer usually presents with symptoms due to direct extension into adjacent viscera, distant metastases from lymphatic or hematogenic dissemination and peritoneal seeding. However, portal hypertension as a presentation of metastatic gastric cancer is rare and usually seen in association with other malignancies, e.g. hepatocellular and pancreatic carcinoma. We report a case of signet ring adenocarcinoma of the stomach that presented with esophageal and duodenal varices and bleeding due to portal hypertensive gastropathy. Pagetoid spread of cancer cells likely caused early metastasis and the unusual presentation. We also discussed the pathophysiology of development of portal hypertension in association with malignancies.
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Affiliation(s)
- Pradipta Ghosh
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Diego, CA 92161, USA.
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26
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Giglio P, Weinberg JS, Forman AD, Wolff R, Groves MD. Neoplastic meningitis in patients with adenocarcinoma of the gastrointestinal tract. Cancer 2005; 103:2355-62. [PMID: 15856426 DOI: 10.1002/cncr.21082] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neoplastic meningitis (NM) occurs in 5-10% of patients with malignant disease. Little is known about the outcomes of patients with gastrointestinal (GI) malignancies who develop NM. For this report, the authors characterized the clinical course and attempted to identify prognostic factors in patients with NM due to primary malignancies of the GI tract. METHODS In this retrospective study, 21 patients with GI primary tumors and NM were identified: Their medical records and imaging studies were reviewed. RESULTS The patient population was composed of patients with gastric adenocarcinoma (n = 8 patients), esophageal adenocarcinoma (n = 7 patients), colon and/or rectal adenocarcinoma (n = 5 patients), and pancreatic adenocarcinoma (n = 1 patient). The median overall survival after the initial diagnosis of adenocarcinoma was 55 weeks (range, 8-884 wks), and the median survival after the diagnosis of NM was 7 weeks (range, 0-64 wks). Four patients died during palliative radiotherapy. No factors identified had an impact on outcome, including symptoms, physical findings at diagnosis, imaging characteristics, or cerebrospinal fluid findings. Univariate analysis showed a trend toward better outcomes for patients who received any kind of treatment directed toward the NM. CONCLUSIONS Patients with NM from GI tract adenocarcinomas universally had poor outcomes. Until NM can be diagnosed earlier and/or until more effective therapies are identified, comfort care alone may be a reasonable alternative for some of these unfortunate patients.
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Affiliation(s)
- Pierre Giglio
- Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center Brain Tumor Center, Houston, Texas 77030, USA
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