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Smets L, Claerhout H, Van Laer C, Boeckx N. Malignant invasion of the cerebrospinal fluid in adult and paediatric patients with haematological and solid malignancies: a monocentric retrospective study. Acta Clin Belg 2022; 77:524-532. [PMID: 33729099 DOI: 10.1080/17843286.2021.1900493] [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: 10/21/2022]
Abstract
OBJECTIVES In this study, we describe the clinical presentation, the cerebrospinal fluid (CSF) characteristics and outcome of children and adults with leptomeningeal invasion due to haematological and solid malignancies. METHODS Routine CSF samples analyzed from 2008 to 2018 at our institution were retrospectively reviewed for the presence of malignant cells based on cytomorphological analysis. RESULTS Leptomeningeal invasion was identified in 212 patients: 45 children versus 167 adults, and 92 haematological versus 120 solid malignancies. Leukaemic invasion in childhood was mainly due to ALL, and lymphoma invasion was often due to a high-grade B-cell lymphoma in adults. Metastatic invasion by solid tumours was almost exclusively seen in adults. Patients suffered most frequently from cranial neuropathy and headache (both 32%), while asymptomatic presentations were seen mainly in children (33%) and haematological malignancies (17%). Laboratory CSF parameters often showed an elevated WBC count (87%), total protein (74%) and lactate (76%) and a decreased glucose (77%). These deviations were especially found in solid malignancies (>84%) and adults (>82%). Brain and/or spinal cord imaging was more often suggestive for the leptomeningeal invasion in solid than in haematological malignancies (86% vs. 46%). The 5-year overall survival (OS) rates for patients with haematological and solid malignancies were 21.5% and 5.9%, respectively. The 5-year OS rate for children (55.6%) was significantly better than for adults (3.5%). CONCLUSION Leptomeningeal invasion is more often asymptomatic, and CSF parameters and imaging are more often normal in children and haematological malignancies than in adults and solid malignancies, possibly leading to underdiagnosis.
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Affiliation(s)
- Leonie Smets
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Helena Claerhout
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Christine Van Laer
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium. Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, Leuven, Belgium
| | - Nancy Boeckx
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium. Departement of Oncology, Leuven, Belgium
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Minter DJ, Richie M, Kumthekar P, Hollander H. Stalking the Diagnosis. N Engl J Med 2021; 384:1262-1267. [PMID: 33789016 DOI: 10.1056/nejmcps2028560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Daniel J Minter
- From the Departments of Medicine (D.J.M., H.H.) and Neurology (M.R.) and the Division of Infectious Diseases (H.H.), University of California, San Francisco, San Francisco; and the Department of Neurology and the Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago (P.K.)
| | - Megan Richie
- From the Departments of Medicine (D.J.M., H.H.) and Neurology (M.R.) and the Division of Infectious Diseases (H.H.), University of California, San Francisco, San Francisco; and the Department of Neurology and the Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago (P.K.)
| | - Priya Kumthekar
- From the Departments of Medicine (D.J.M., H.H.) and Neurology (M.R.) and the Division of Infectious Diseases (H.H.), University of California, San Francisco, San Francisco; and the Department of Neurology and the Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago (P.K.)
| | - Harry Hollander
- From the Departments of Medicine (D.J.M., H.H.) and Neurology (M.R.) and the Division of Infectious Diseases (H.H.), University of California, San Francisco, San Francisco; and the Department of Neurology and the Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago (P.K.)
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3
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Andugulapati SS, Chheda A, Desai K, Ravat SH. Diagnostic challenges in neoplastic meningitis presenting as intracranial hypertension. BMJ Case Rep 2021; 14:14/3/e238808. [PMID: 33692049 PMCID: PMC7949390 DOI: 10.1136/bcr-2020-238808] [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] [Indexed: 11/04/2022] Open
Abstract
A diagnosis of idiopathic intracranial hypertension should be considered only after careful exclusion of all possible aetiologies. We report a case of neoplastic meningitis presenting as intracranial hypertension with inconclusive repeated cerebrospinal fluid (CSF) cytology and MRI of brain, emphasising the importance of meticulous CSF analysis and role of early whole-body PET-CT scan for diagnosis of systemic malignancy.
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Affiliation(s)
| | - Akash Chheda
- Department of Neurology, Seth GS Medical College and KEM Hospital, Mumbai, Maharastra, India
| | - Karan Desai
- Department of Neurology, Seth GS Medical College and KEM Hospital, Mumbai, Maharastra, India
| | - Sangeeta Hasmukh Ravat
- Department of Neurology, Seth GS Medical College and KEM Hospital, Mumbai, Maharastra, India
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Torelli S, Lenka A, Khan F, Amjad F. Clinical Reasoning: An 81-year-old woman with confusion, weakness, and left-sided hemineglect. Neurology 2020; 95:e3060-e3064. [PMID: 32727841 DOI: 10.1212/wnl.0000000000010472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Stefan Torelli
- From the Department of Neurology, MedStar Georgetown University Hospital, Washington, DC
| | - Abhishek Lenka
- From the Department of Neurology, MedStar Georgetown University Hospital, Washington, DC.
| | - Fahad Khan
- From the Department of Neurology, MedStar Georgetown University Hospital, Washington, DC
| | - Faria Amjad
- From the Department of Neurology, MedStar Georgetown University Hospital, Washington, DC
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5
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Tattevin P, Tchamgoué S, Belem A, Bénézit F, Pronier C, Revest M. Aseptic meningitis. Rev Neurol (Paris) 2019; 175:475-480. [PMID: 31375286 DOI: 10.1016/j.neurol.2019.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/17/2022]
Abstract
Aseptic meningitis is defined as meningeal inflammation - i.e. cerebrospinal fluid (CSF) pleocytosis≥5 cells/mm3 - not related to an infectious process. Etiologies of aseptic meningitis can be classified in three main groups: (i) systemic diseases with meningeal involvement, which include sarcoidosis, Behçet's disease, Sjögren's syndrome, systemic lupus erythematosus and granulomatosis with polyangiitis; (ii) drug-induced aseptic meningitis, mostly reported with non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics (sulfamides, penicillins), intravenous immunoglobulin, and monoclonal antibodies; (iii) neoplastic meningitis, either related to solid cancer metastasis (breast cancer, lung cancer, melanoma) or malignant hemopathy (lymphoma, leukemia). Most series in the literature included groups of meningitis that are not stricto sensu aseptic, but should rather be included in the differential diagnosis: (i) infectious meningitis related to virus, parasites, fungi, or fastidious bacteria that require specific diagnostic investigations; (ii) bacterial meningitis with sterile CSF due to previous antibiotic administration, and (iii) parameningeal infections associated with meningeal reaction. Despite progress in microbiological diagnosis (including PCR, and next generation sequencing), and identification of a growing panel of autoimmune or paraneoplastic neurological syndromes, up to two thirds of aseptic meningitis cases are of unknown etiology, finally labeled as 'idiopathic'. Description of new entities, such as the syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) may decrease the proportion of idiopathic aseptic meningitis. This state-of-the-art review summarizes the characteristics of main causes of aseptic meningitis.
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Affiliation(s)
- P Tattevin
- Service de maladies infectieuses et réanimation médicale, CHU de Pontchaillou, rue Le Guilloux, 35033 Rennes Cedex, France.
| | - S Tchamgoué
- Médecine interne, centre hospitalier, 33500 Libourne, France
| | - A Belem
- Service de maladies infectieuses et réanimation médicale, CHU de Pontchaillou, rue Le Guilloux, 35033 Rennes Cedex, France
| | - F Bénézit
- Service de maladies infectieuses et réanimation médicale, CHU de Pontchaillou, rue Le Guilloux, 35033 Rennes Cedex, France
| | - C Pronier
- Virologie, CHU de Pontchaillou, 35033 Rennes Cedex, France
| | - M Revest
- Service de maladies infectieuses et réanimation médicale, CHU de Pontchaillou, rue Le Guilloux, 35033 Rennes Cedex, France
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Chun-Yin LW, Hin Ian LY, Hil-Ching Hilary K, Shek-Kwan CR. Pitfalls in cerebrospinal fluid analysis: A case report of carcinomatous meningitis mimicking infective causes. J Formos Med Assoc 2019; 118:953-954. [PMID: 30826208 DOI: 10.1016/j.jfma.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Leung Yu Hin Ian
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, China
| | | | - Chang Richard Shek-Kwan
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, China.
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Little J, Rajkumar C, Saleem W. A rare case of malignant meningitis from a likely bronchogenic melanoma primary cancer. Oxf Med Case Reports 2019; 2019:omy114. [PMID: 30697431 PMCID: PMC6345080 DOI: 10.1093/omcr/omy114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/18/2018] [Accepted: 10/28/2018] [Indexed: 12/02/2022] Open
Abstract
Malignant meningitis is a rare condition with varied clinical presentations, often mimicking other neurological conditions. Here we report a rare case of malignant meningitis from primary bronchogenic melanoma. The patient initially presented with vomiting and headache. Over the next 12 days she developed rapidly progressive neurology: losing mental faculties, vision, hearing and limb power. Lumbar puncture results revealed malignant cells. Computer tomography of the chest found an endobronchial lesion which was later biopsied and histology revealed a melanoma. This condition is very rare and diagnosis was difficult. We discuss ideas to help expedite diagnosis and management of such cases in the future.
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Affiliation(s)
- Jessica Little
- Department of Oncology, Imperial College Healthcare NHS Trust, Charring Cross Hospital, Fulham Palace Road, London, UK
| | - Christopher Rajkumar
- Department of Endocrinology, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, UK
| | - Waqar Saleem
- Department of Oncology, Imperial College Healthcare NHS Trust, Charring Cross Hospital, Fulham Palace Road, London, UK
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Suresh PK, Kini JR, Basavaiah SH, Kini H, Khadilkar UN, Chakraborti S. Neoplastic Meningitis: A Study from a Tertiary Care Hospital from Coastal India. J Cytol 2018; 35:255-259. [PMID: 30498301 PMCID: PMC6210820 DOI: 10.4103/joc.joc_167_17] [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] [Indexed: 11/18/2022] Open
Abstract
Introduction: Neoplastic involvement of cerebrospinal fluid (CSF) secondary to known or unknown primaries elsewhere is a poor prognostic factor and is equivalent to stage IV disease. Aim: The aim of the study is to analyse the cytological features of neoplastic meningitis in a tertiary care center. Materials and Methods: A retrospective study of 400 consecutive CSF samples was done in the cytology laboratory of our hospital. The fluid obtained by spinal tap was sent for microbiological, biochemical and cytological evaluation. Smears that showed the presence of malignant cells were included in this study. Results: Out of 400 cases, 36 (9%) showed neoplastic meningitis. Of which, 13 cases (36%) revealed leukemic infiltration, 2 (6%) lymphomatous infiltration and 21 (58%) carcinomatous meningitis. The leukemia cases included seven cases of acute lymphoblastic leukemia and six cases of acute myeloid leukemia. Among the carcinomatous meningitis cases, eight were metastasis from carcinoma breast, six from lung carcinoma and one each from malignancies of gallbladder, stomach and retinoblastoma. Four cases were metastatic adenocarcinoma from unknown primary. Pleocytosis was a significant finding seen in 58% cases (n = 21). Elevated protein and hypoglychorrhachia was noted in 68% cases (n = 18). Conclusion: A combined diagnostic approach including biochemical, microbiological and pathological evaluation was useful in eliminating infectious meningitis and confirming neoplastic meningitis in these cases. Cytology should be performed on cerebrospinal specimens from all patients with known or suspected malignancy with meningismus. Detection of malignant cells on cytological examination of CSF is the diagnostic gold standard for neoplastic meningitis.
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Affiliation(s)
- Pooja K Suresh
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Jyoti Ramanath Kini
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Sridevi H Basavaiah
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Hema Kini
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Urmila N Khadilkar
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Shrijeet Chakraborti
- Department of Cellular Pathology, Leighton Hospital, Crewe, Cheshire, United Kingdom
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De Potter B, Huyskens J, Hiddinga B, Spinhoven M, Janssens A, van Meerbeeck JP, Parizel PM, Snoeckx A. Imaging of urgencies and emergencies in the lung cancer patient. Insights Imaging 2018; 9:463-476. [PMID: 29644546 PMCID: PMC6108967 DOI: 10.1007/s13244-018-0605-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 12/15/2022] Open
Abstract
Lung cancer patients often experience potentially life-threatening medical urgencies and emergencies, which may be a direct or indirect result of the underlying malignancy. This pictorial review addresses the most common thoracic, neurological and musculoskeletal medical emergencies in lung cancer patients, including superior vena cava syndrome, pulmonary embolism, spontaneous pneumothorax, cardiac tamponade, massive haemoptysis, central airway obstruction, oesophagorespiratory fistula, malignant spinal cord compression, carcinomatous meningitis, cerebral herniation and pathological fracture. Emphasis is placed on imaging findings, the role of different imaging techniques and a brief discussion of epidemiology, pathophysiology and therapeutic options. Since early diagnosis is important for adequate patient management and prognosis, radiologists have a crucial role in recognising and communicating these urgencies and emergencies. TEACHING POINTS • Multiplanar multidetector computed tomography is the imaging examination of choice for thoracic urgencies and emergencies. • Magnetic resonance imaging is the imaging modality of choice for investigating central nervous system emergencies. • Urgencies and emergencies can be the initial manifestation of lung cancer. • Radiologists have a crucial role in recognising and in communicating these urgencies/emergencies.
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Affiliation(s)
- Bruno De Potter
- Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - Jef Huyskens
- Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Birgitta Hiddinga
- Department of Thoracic Oncology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
- Department of Thoracic Oncology, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands
| | - Maarten Spinhoven
- Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Annelies Janssens
- Department of Thoracic Oncology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Jan P van Meerbeeck
- Department of Thoracic Oncology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Paul M Parizel
- Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Annemie Snoeckx
- Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
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