Meningeal carcinomatosis as the first manifestation of a transitional cell carcinoma of the bladder

Meningeal carcinomatosis (MC) as first manifestation of a transitional cell carcinoma (TCC) of the bladder is rare. We report a 66-year-old man, smoker, who presented with two episodes of secondarily generalized partial motor seizures. The routine blood test, brain computed tomography (CT) scan, brain magnetic resonance imaging and electroencephalogram were normal. Cerebral spinal fluid (CSF) revealed a significant pleocytosis and a morphology compatible with non-differentiated non-small cell carcinoma. Broncofiberscopy, gastrofiberscopy, thoracicoabdominopelvic CT-scan and bone scintigraphy were normal but the urine cytology revealed malignant cells similar to those found in the CSF. TCC was diagnosed by cystoscopy and later necropsy confirmed the MC of this tumor. In this report we review the literature and analyze patient survival.

[Sudden bilateral hearing loss disclosing meningeal carcinomatosis]

We report the case of a patient presenting a sudden bilateral hearing loss. Four years before, a bladder carcinoma was resected and a chemotherapy was started. Gadolinium-enhanced magnetic resonance images revealed enhancement of both acoustic nerves. Cerebrospinal fluid analysis showed malignant cells consistent with the initial bladder cancer. Meningeal metastases from bladder carcinoma are extremely rare. Systemic chemotherapy and its low meningeal diffusion may enhance the incidence of this complication. Bilateral hearing loss is a rare initial manifestation of meningeal carcinomatosis.

Cerebrospinal fluid and metastasis of transitional cell carcinoma of the bladder

Two cases are presented of cerebrospinal fluid with tumor cells metastatic from transitional cell carcinomas of the bladder. They demonstrate that in spite of the rarity of transitional cell carcinoma's metastasizing to the central nervous system (0.4% to 0.6%), it is necessary to consider the bladder as the primary site and to obtain urinary cytology in such cases when the primary tumor is still unknown.

Cytopathology of nonlymphoreticular neoplasms metastatic to the central nervous system

During a period of two years (1977 to 1978), 5,185 cerebrospinal fluid (CSF) specimens were examined in the Cytology Laboratory of Memorial Sloan-Kettering Cancer Center. Malignant cells were identified in 853 specimens. Of the positive specimens, 524 were obtained from 118 patients with nonlymphoreticular metastatic neoplasms. The most common tumors were mammary carcinoma (37%), pulmonary carcinoma (27%) and malignant melanoma (18%). The majority of epithelial tumors (77%) were adenocarcinomas. The interval between the primary diagnosis of malignancy and the time of first positive cytology varied significantly according to the type of neoplasm. The interval was approximately five times longer in patients with breast carcinoma and malignant melanoma (52 months) than in cases of lung carcinoma and bladder carcinoma (11 and 9 months, respectively). The prognosis, however, was invariably grave. Seventy-five percent of patients with follow-up died within 100 days of the first positive CSF. The tumor cells were often relatively small, with slight anisocytosis and pleomorphism as compared to their counterparts in other cytologic material. Cytology of the various neoplasms is presented, with attention to the morphologic changes during the follow-up period.