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Okubo Y, Ueta Y, Taguchi T, Kato H, Terashi H, Aizawa H. [A case of meningeal carcinomatosis mimicking subarachnoid hemorrhage on MRI]. Rinsho Shinkeigaku 2018; 58:403-406. [PMID: 29863102 DOI: 10.5692/clinicalneurol.cn-001151] [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: 11/05/2022]
Abstract
We report a case of meningeal carcinomatosis that needed to be distinguished from subarachnoid hemorrhage. A 67-year-old female with acute severe headache was admitted to a previous hospital. Since high intensity signal was detected within the parietal cerebral sulci on the right side on brain FLAIR MRI, cerebral angiography was performed due to suspicion of subarachnoid hemorrhage. However, no vascular abnormality was observed. Then, cerebral spinal fluid was collected, which showed an increase in cell count, suggesting meningitis. She was transferred to our hospital for evaluation of neurological disease. After admission to our hospital, there was an episode of hematemesis. Upper gastrointestinal endoscopy was performed, and advanced gastric cancer was found. She was diagnosed as having meningeal carcinomatosis due to gastric cancer. Meningeal carcinomatosis should be considered in addition to subarachnoid hemorrhage when a patient with acute headache shows high intensity signal within the cerebral sulci on brain FLAIR MRI.
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Affiliation(s)
| | - Yuki Ueta
- Department of Neurology, Tokyo Medical University
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2
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Doval DC, Azam S, Sinha R, Batra U, Mehta A, Rao A. A Report of Two Cases of Leptomeningeal Carcinomatosis Arising from Gallbladder Carcinoma. J Gastrointest Cancer 2015; 46:417-20. [PMID: 25863810 DOI: 10.1007/s12029-015-9719-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Sector-5, Rohini, Delhi, India. .,Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India.
| | - Saud Azam
- Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Rupal Sinha
- Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Sector-5, Rohini, Delhi, India
| | - Anurag Mehta
- Department of Laboratory Services, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Avinash Rao
- Department of Radiology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
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Treatment of Leptomeningeal Carcinomatosis in a Patient With Metastatic Cholangiocarcinoma. ACG Case Rep J 2014; 2:39-41. [PMID: 26157901 PMCID: PMC4435345 DOI: 10.14309/crj.2014.78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/15/2014] [Indexed: 12/04/2022] Open
Abstract
A 49-year-old woman with cholangiocarcinoma metastatic to the lungs presented with new-onset unrelenting headaches. A lumbar puncture revealed malignant cells consistent with leptomeningeal metastasis from her cholangiocarcinoma. Magnetic resonance imaging (MRI) of the brain revealed leptomeningeal enhancement. An intrathecal (IT) catheter was placed and IT chemotherapy was initiated with methotrexate. Her case is notable for the rarity of cholangiocarcinoma spread to the leptomeninges, the use of IT chemotherapy with cytologic and potentially symptomatic response, and a possible survival benefit in comparison to previously reported cases of leptomeningeal carcinomatosis secondary to cholangiocarcinoma.
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Neurological and cytological response as potential early predictors of time-to-progression and overall survival in patients with leptomeningeal carcinomatosis treated with intrathecal liposomal cytarabine: a retrospective cohort study. J Neurooncol 2013; 115:429-35. [DOI: 10.1007/s11060-013-1241-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 09/02/2013] [Indexed: 10/26/2022]
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Kim YG, Kim EH, Kim SH, Chang JH. Solitary primary leptomeningeal glioma: case report. Brain Tumor Res Treat 2013; 1:36-41. [PMID: 24904888 PMCID: PMC4027116 DOI: 10.14791/btrt.2013.1.1.36] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/10/2013] [Accepted: 04/18/2013] [Indexed: 11/20/2022] Open
Abstract
We report a case of solitary primary leptomeningeal glioma. The mass was totally removed under awake surgery. Intraoperatively, no parenchymal involvement was noted. Histopathological study revealed a predominant anaplastic oligodendroglioma component and a focal anaplastic astrocytoma component, which was consistent with an anaplastic oligoastrocytoma. Adjuvant tomotherapy was followed and the tumor has not recurred until 12 months after surgery. A focal type of primary leptomeningeal glioma is extremely rare. We report a rare case of solitary primary leptomeningeal anaplastic oligoastrocytoma.
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Affiliation(s)
- Young Goo Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eui Hyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea. ; Neuro-Oncology Clinic, Yonsei University College of Medicine, Seoul, Korea. ; Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea. ; Neuro-Oncology Clinic, Yonsei University College of Medicine, Seoul, Korea. ; Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea. ; Neuro-Oncology Clinic, Yonsei University College of Medicine, Seoul, Korea. ; Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Chaudhary S, Klein M, Mehrotra B, Morgenstern NJ. Utility of immunocytochemistry in diagnosing leptomeningeal metastases from an intrahepatic cholangiocarcinoma. Diagn Cytopathol 2013; 42:54-7. [DOI: 10.1002/dc.22946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 12/04/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Shweta Chaudhary
- Department of Pathology; North Shore Long Island Jewish Health System; Lake Success New York
| | - Melissa Klein
- Department of Pathology; North Shore Long Island Jewish Health System; Lake Success New York
| | - Bhoomi Mehrotra
- Department of Surgery; Long Island Jewish Medical Center; New Hyde Park New York
| | - Nora J. Morgenstern
- Department of Pathology; North Shore Long Island Jewish Health System; Lake Success New York
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Liu J, Jia H, Yang Y, Dai W, Su X, Zhao G. Cerebrospinal Fluid Cytology and Clinical Analysis of 34 Cases with Leptomeningeal Carcinomatosis. J Int Med Res 2009; 37:1913-20. [PMID: 20146891 DOI: 10.1177/147323000903700629] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The clinical characteristics and cerebrospinal fluid (CSF) cytological features of 34 hospitalized patients with leptomeningeal carcinomatosis (LC) were studied. Most patients presented with signs of meningeal irritation (19 cases) and intra-cranial hypertension (23 cases). Computed tomography (CT) and/or magnetic resonance imaging (MRI) revealed brain parenchymal lesions, hydrocephalus and leptomeningeal enhancement (nine, six and eight cases, respectively). The CSF changes included high opening pressure (21 cases), increased white blood cell count (23 cases), elevated protein levels (25 cases) and low glucose levels (17 cases). Malignant cells were found in all CSF specimens and 32 cases had malignant cells in their initial CSF examinations. High serum levels of carcinoembryonic antigen (CEA) occurred in 11 patients. Signs of meningeal irritation and intra-cranial hypertension were common. It is concluded that serum CEA measurement along with CT and MRI scanning are helpful in the diagnosis of LC. Crucially, however, CSF cytology could be the most important technique for the diagnosis of LC.
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Affiliation(s)
- J Liu
- Department of Neurology, Xijing Hospital of the Fourth Military Medical University, Xi'an City, Shaanxi Province, China
| | - H Jia
- Department of Neurology, Xijing Hospital of the Fourth Military Medical University, Xi'an City, Shaanxi Province, China
| | - Y Yang
- Department of Neurology, Xijing Hospital of the Fourth Military Medical University, Xi'an City, Shaanxi Province, China
| | - W Dai
- Department of Neurology, Xijing Hospital of the Fourth Military Medical University, Xi'an City, Shaanxi Province, China
| | - X Su
- Department of Neurology, Xijing Hospital of the Fourth Military Medical University, Xi'an City, Shaanxi Province, China
| | - G Zhao
- Department of Neurology, Xijing Hospital of the Fourth Military Medical University, Xi'an City, Shaanxi Province, China
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Ko MW, Turkeltaub PE, Lee EB, Gonatas NK, Volpe NJ, Moster ML, Galetta SL. Primary diffuse leptomeningeal gliomatosis mimicking a chronic inflammatory meningitis. J Neurol Sci 2009; 278:127-31. [DOI: 10.1016/j.jns.2008.11.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 11/19/2008] [Accepted: 11/21/2008] [Indexed: 11/28/2022]
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King JAJ, Halliday W, Drake JM. High-grade primary diffuse leptomeningeal gliomatosis in a child with neurofibromatosis Type 1. J Neurosurg Pediatr 2008; 2:402-5. [PMID: 19035685 DOI: 10.3171/ped.2008.2.12.402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report on a child with known neurofibromatosis Type 1 who developed high-grade diffuse leptomeningeal gliomatosis, without a known primary glioma. To the authors' knowledge, this is the first report of the coexistence of these conditions in a child.
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Affiliation(s)
- James A J King
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Gonçalves AL, Masruha MR, Carrete H, Stávale JN, Silva NSD, Vilanova LCP. Primary diffuse leptomeningeal gliomatosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:85-7. [PMID: 18392423 DOI: 10.1590/s0004-282x2008000100021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- André Leite Gonçalves
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Okamura Y, Harada A, Maeda A, Fujioka A, Horiba T, Ishigure K, Hirai A, Ito Y, Uesaka K. Carcinomatous meningitis secondary to cholangiocarcinoma without other systemic metastasis. ACTA ACUST UNITED AC 2008; 15:237-9. [DOI: 10.1007/s00534-007-1249-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 06/19/2007] [Indexed: 10/22/2022]
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Affiliation(s)
- William P O'Meara
- Department Radiation Oncology, National Naval Medical Center, Bethesda, Maryland, USA
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Hildebrandt B, Müller C, Pezzutto A, Daniel PT, Dörken B, Scholz C. Assessment of free light chains in the cerebrospinal fluid of patients with lymphomatous meningitis - a pilot study. BMC Cancer 2007; 7:185. [PMID: 17915026 PMCID: PMC2194780 DOI: 10.1186/1471-2407-7-185] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 10/03/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphomatous meningitis (LM) represents a severe complication of malignant lymphomas. While clinical suspicion is raised by symptoms ranging from mild disturbances of sensation to severe pain or impaired consciousness, the definite diagnosis of LM is often difficult to obtain. Since B-cell lymphomas are clonally restricted to express either kappa or lambda immunoglobulin light chain, we hypothesised that analysis of free light chain (FLC) ratios might facilitate the diagnosis of LM. METHODS Kappa and lambda FLC were measured using a novel nephelometric assay in cerebrospinal fluid (CSF) and serum from 17 patients. 5/17 suffered from LM as demonstrated by cytology, immunocytology, and/or imaging procedures. RESULTS Measurement of FLC concentrations in CSF was achieved for all 17 patients. FLC levels in CSF were lower than serum FLC levels in samples for the same patient obtained at the same time (p < 0.01). CSF and serum FLC concentrations correlated weakly in all patients irrespective of LM status. Significantly more patients with cytopathologically and immunohistochemically proven LM displayed abnormal kappa/lambda FLC ratios in CSF compared to individuals with no LM (p < 0.01). CONCLUSION This is the first report demonstrating that a significant proportion of LM patients display an abnormal kappa/lambda FLC ratio in the CSF.
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Affiliation(s)
- B Hildebrandt
- Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - C Müller
- Zentrum für Diagnostische und Präventive Labormedizin, Zentralinstitut für Laboratoriumsmedizin und Pathobiochemie, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - A Pezzutto
- Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - PT Daniel
- Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - B Dörken
- Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - C Scholz
- Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
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Yomo S, Tada T, Hirayama S, Tachibana N, Otani M, Tanaka Y, Hongo K. A case report and review of the literature. J Neurooncol 2006; 81:209-16. [PMID: 17031563 DOI: 10.1007/s11060-006-9219-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 07/10/2006] [Indexed: 11/27/2022]
Abstract
Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare central nervous system neoplasm in which gliomatous tissue is diffusely identified in the subarachnoid space with no evidence of a primary intraparenchymal tumor. A 52-year-old man presented low back pain followed by sudden unconsciousness and had also cognitive dysfunction and meningeal sign. Examinations of cerebrospinal fluid (CSF) did not show malignant cells but increased protein and pleocytosis. Magnetic resonance (MR) imaging demonstrated diffuse leptomeningeal enhancement without any source of intraparenchymal lesion. Fluid-attenuated inversion recovery (FLAIR) also demonstrated individual diffuse high intensity area in the subarachnoid space. A biopsy disclosed wide spreading of anaplastic glial cells within the leptomeninges. He died 3 months later because of disease progression despite both radiotherapy and chemotherapy. Post-mortem examination identified PDLG and several neuropathological features of glioblastoma as well. Reviewing previous cases of PDLG instructs that this entity is rare, resembles meningitis in clinical pictures, usually occurs in a relatively younger population and has more progressive clinical course than the ordinary form of malignant gliomas.
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Affiliation(s)
- Shoji Yomo
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
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Affiliation(s)
- Eric Prommer
- Hematology/Oncology/Veterans Intergerated Palliative Care Program, Greater Los Angeles Healthcare, Los Angeles, California 90073, USA.
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Bilic M, Welsh CT, Rumboldt Z, Hoda RS. Disseminated primary diffuse leptomeningeal gliomatosis: a case report with liquid based and conventional smear cytology. Cytojournal 2005; 2:16. [PMID: 16174291 PMCID: PMC1239923 DOI: 10.1186/1742-6413-2-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 09/20/2005] [Indexed: 11/23/2022] Open
Abstract
Background Primary diffuse leptomeningeal gliomatosis is a rare neoplasm confined to the meninges without evidence of primary tumor in the brain or spinal cord parenchyma. Cerebrospinal fluid diversion via ventriculoperitoneal shunt may be used as a therapeutic modality. Herein, we describe the first report of cytologic findings of a case of this neoplasm with shunt-related peritoneal metastasis. Case presentation A 19-year-old male presented with a 6-month history of severe headaches. He had bilateral papilledema on physical exam. Cerebrospinal fluid examination was negative. Four months later a ventriculoperitoneal shunt was placed. Shortly thereafter, he was diagnosed with primary diffuse leptomeningeal gliomatosis based on the biopsy of an intradural extramedullary lesion adjacent to the lumbar spinal cord at a referral cancer center. The histology featured an infiltrating growth pattern of pleomorphic astrocytes with diffuse positivity for glial fibrillary acidic protein. A couple of months later he presented at our institution with ascites and an anterior peritoneal mass. Repeat cerebrospinal fluid cytology and fine needle aspiration of the mass confirmed disseminated gliomatosis. Cytologic characteristics included clusters of anaplastic cells of variable size, high nuclear to cytoplasm ratio and scant to moderate cytoplasm. Occasional single bizarre multinucleated cells were seen with eccentric "partial wreath-like" nuclei, clumped chromatin and prominent nucleoli. Patient expired 13 months after initial presentation. Conclusion Disseminated primary diffuse leptomeningeal gliomatosis should be considered in the differential diagnosis of chronic aseptic meningitis and in the presence of a peritoneal tumor in patients with ventriculoperitoneal shunts. Immunocytochemistry may be of diagnostic value.
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Affiliation(s)
- Masha Bilic
- Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Cynthia T Welsh
- Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Zoran Rumboldt
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Rana S Hoda
- Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
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Abstract
Leptomeningeal metastasis, also known as neoplastic meningitis, carcinomatous meningitis, and meningeal carcinomatosis, occurs when cancer cells gain access to cerebrospinal fluid pathways, travel to multiple sites within the central nervous system, settle, and grow. This disease has become an increasingly important late complication in oncology as patients survive longer, develop more brain metastases, and newer chemotherapies fail to penetrate the blood-brain barrier. The hallmark of clinical presentation is a cancer patient who complains of focal neurologic dysfunction and is found to have multifocal signs on neurologic examination. The clinical course is relentlessly progressive; treatment is limited and cures are the subject of case reports. This article reviews the clinical course of leptomeningeal metastasis and addresses recent developments in its pathophysiology, diagnosis, and treatment.
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Affiliation(s)
- Alexis Demopoulos
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10019, USA.
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Miyagui T, Luchemback L, Teixeira GHMDC, de Azevedo KML. Meningeal carcinomatosis as the initial manifestation of a gallbladder adenocarcinoma associated with a Krukenberg tumor. REVISTA DO HOSPITAL DAS CLINICAS 2003; 58:169-72. [PMID: 12894314 DOI: 10.1590/s0041-87812003000300007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A case of malignant neoplasm is described in which the initial manifestations were mental dysfunction and meningeal irritation, mimicking chronic or subacute meningitis. Physical examination showed cranial nerve involvement and a pelvic tumor. There was progressive deterioration, and death occurred in 2 weeks. The autopsy revealed a gallbladder adenocarcinoma, meningeal carcinomatosis, and ovarian metastasis presenting as a Krukenberg tumor. The authors emphasize the importance of including meningeal carcinomatosis as a possibility in the differential diagnosis of non-characteristic clinical pictures, as well as the importance of the cerebrospinal fluid cytologic examination, repeated as needed, in order to confirm this diagnosis.
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Affiliation(s)
- Tizuko Miyagui
- Departments of Pathology and Clinical Medicine, Infectious and Parasitic Disease Service, Antonio Pedro University Hospital, Faculty of Medicine, Fluminense Federal University, Rio de Janeiro, RJ, Brazil
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Abstract
LM is an increasingly common neurologic complication of cancer with variable clinical manifestations. Although there are no curative treatments, currently available therapies can preserve neurologic function and potentially improve quality of life. Further research into the mechanisms of leptomeningeal metastasis will elucidate molecular and cellular pathways that may allow identification of potential targets to interrupt this process early or to prevent this complication. Animal models are needed to further define the pathophysiology of LM and to provide an experimental system to test novel treatments [242-245]. There is an urgent need to develop new drug-based or radiation-based treatments for patients with LM. Randomized clinical trials are the appropriate study design to determine the efficacy of new treatments for LM. However, surrogate markers for response must be developed to facilitate the identification of effective regimens. Survival is not the optimal end point for such studies as most patients who develop this complication already have advanced, incurable cancer. Prevention of or delay in neurologic progression is one objective that has been utilized in recent randomized trials in patients with LM, and this end point deserves further attention. Although the development of LM represents a poor prognostic marker in patients with cancer it is important for physicians to recognize the symptoms and signs of the disease and establish the diagnosis as early in the disease course as possible. This may provide an opportunity for effective intervention that can improve quality of life, prevent further neurologic deterioration and, for a subset of patients, improve survival.
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Affiliation(s)
- Santosh Kesari
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA 02114, USA
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Roma AA, Garcia A, Avagnina A, Rescia C, Elsner B. Lymphoid and myeloid neoplasms involving cerebrospinal fluid: comparison of morphologic examination and immunophenotyping by flow cytometry. Diagn Cytopathol 2002; 27:271-5. [PMID: 12411991 DOI: 10.1002/dc.10190] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We studied 53 samples of cerebrospinal fluid (CSF) by cytologic examination and immunophenotyping by flow cytometry. The samples were taken from 43 patients; 25 had a previous diagnosis of malignant lymphoma/leukemia and the remaining 18 a variety of other diseases involving the central nervous system (CNS). Lymphoma/leukemia was detected in 21 samples: 12 by morphologic examination and immunophenotyping and nine by immunophenotyping alone. There were two cases with a suspicious morphologic examination and negative immunophenotyping in which the final diagnosis were cryptococcal and viral meningitis. In the group of 18 patients, one was diagnosed as a primary malignant lymphoma of the CNS and was positive with cytology and immunophenotyping. The other 17 were negative with both methods and follow-up showed no evidence of lymphoma/leukemia. This study shows that morphologic examination combined with flow cytometry enhances the detection rate by 75% over morphologic examination alone in CSF samples.
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Affiliation(s)
- Andres A Roma
- Center for Medical Education and Clinical Investigations, Buenos Aires, Argentina.
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Dhooge C, Van Coster R, de Jaeger A, Vandecruys E, Laureys G, Vanzieleghem B. Meningeal carcinomatosis in a child with Ewing sarcoma. MEDICAL AND PEDIATRIC ONCOLOGY 2002; 38:297-9. [PMID: 11920806 DOI: 10.1002/mpo.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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