Sequential spinal and intracranial dural metastases in gastric adenocarcinoma: A case report

Pachymeningeal en plaque metastasis from gastric cancer mimicking subdural hematoma: illustrative case

BACKGROUND

Pachymeningeal metastasis associated with gastric cancer, especially in its early stages, is extremely rare.

OBSERVATIONS

The authors describe a 77-year-old man with a past medical history of lung cancer and previously treated chronic subdural hematoma who was admitted to their hospital because of hematemesis and newly diagnosed gastric cancer. He became unconscious during the hospitalization. The preoperative brain imaging studies had the appearance of recurrent subdural hematoma and extracranial tumor with skull invasion. Craniotomy revealed pachymeningeal carcinomatosis and en plaque metastasis of tumor. The histopathology of the tumors was consistent with metastatic gastric adenocarcinoma.

LESSONS

This is the first reported case of metastatic gastric cancer as a pachymeninges-based en plaque entity. This report highlights the rare radiological presentation and operative findings in this case. The authors also summarize those case reports associated with dural metastasis arising from gastric cancer.

The Unique Case of Lumbar Dural Metastasis From Cervical Carcinoma on Pembrolizumab

Lumbar metastasis is a rare manifestation of cervical carcinoma which may present as lower extremities symptoms. Immune-checkpoint inhibitors like pembrolizumab, used for the treatment of various metastatic carcinomas, have been linked to Guillain-Barré Syndrome (GBS), which is characterized by ascending weakness and areflexia. A 52-year-old female with metastatic cervical cancer on pembrolizumab for two months presents with lower back pain, progressive bilateral lower extremities ascending weakness, and areflexia of affected limbs. Cerebrospinal fluid analysis showed albuminocytologic disassociation. Spine magnetic resonance imaging showed L4-L5 fracture associated with metastasis and contrast-enhancing adjacent dura and nerve roots. Despite the clinical presentation being consistent with lumbar metastasis, the possibility of masked pembrolizumab-induced GBS presented a therapeutic challenge. Plasmapheresis conferred no clinical improvement and later nerve conduction study was unrevealing for GBS. Subsequently, laminectomy of lumbar vertebrae improved the symptoms. The unique clinical scenario of lumbar dural metastasis from cervical cancer on pembrolizumab, a condition with a similar clinical presentation, is explored in this case.

Dural Metastasis without Subdural Hematoma or Subdural Fluid Collection in a Patient with Signet Ring Cell Gastric Adenocarcinoma

Patient: Female, 39-year-old

Final Diagnosis: Dural metastasis in signet ring cell gastric adenocarcinoma

Symptoms: Confusion • generalized seizure • headache

Medication: —

Clinical Procedure: —

Specialty: General and Internal Medicine • Oncology