Leptomeningeal Carcinomatosis Originated from Breast Cancer (original) (raw)
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An unusual presentation of carcinomatous meningitis
Oxford medical case reports, 2016
A 67-year old previously well male presented with a 1 week history of confusion on a background of 3 weeks of headache. Past history included two superficial melanomas excised 5 years ago. Treatment for meningoencephalitis was commenced based on lumbar puncture (LP) and non-contrast brain magnetic resonance imaging (MRI) results. Lack of a clinical response to antibiotics resulted in a second LP and contrast brain MRI which demonstrated hydrocephalus and leptomeningeal disease. Ongoing deterioration led to a whole-body computed tomographic and spinal MRI that showed widespread metastatic disease and extensive leptomeningeal involvement of the spinal cord. The diagnosis of metastatic melanoma with carcinomatous meningitis was made based on cytological analysis of cerebrospinal fluid. He died 2 weeks later in a palliative care facility. This case illustrates that the diagnosis of carcinomatous meningitis can be difficult to make as the heterogeneous nature of its presentation often de...
Leptomeningeal carcinomatosis can be presenting manifestation of breast carcinoma
Vojnosanitetski pregled, 2015
Introduction. Leptomeningeal carcinomatosis (LC) is a serious complication occuring in solid cancer patients with rather poor prognosis. Case report. We presented a 47-yearold woman with the 6-month history of diffuse headache, nausea and visual obscuration. Initially, clinical status and brain magnetic resonance imaging (MRI) indicated syndrome of idiopathic intracranial hypertension. Due to clinical progression and high papillary stasis, cerebrospinal fluid (CSF) examination was performed only after ventriculoperitoneal shunt was implanted. This led to a significant although transient clinical improvement. Futher investigations led to the diagnosis of invasive lobular breast carcinoma and repeated CSF analysis revealed malignant breast carcinoma cells. In this case LC was an initial presentation of a malignant disease. Conclusion. In the presence of a high clinical suspicion of LC, in spite of initially negative findings, a clinician should persist in repeating relevant tests, such are MRI with larger amounts of gadolinium and high-volume cytological CSF analyses in order to make the diagnosis.
Different Presentation of Treatment in Carcinomatous Meningitis of Breast Cancer: Report of 3 Cases
Background: Carcinomatous Meningitis (CM) refers to the multifocal seeding of the leptomeninges by malignant cells. CM occurs in approximately 5% of patients with breast cancer. Herein, we suggest that Intrathecal (IT) can use in treatment of breast cancer patients with CM before of any treatment until can prevent of going patient to debilitating phase of this disease. Patients and Methods: Three patients with high risk breast cancer with CM: A 62 year-old Kurdish woman with a history of lung tuberculosis. Her cerebrospinal fluid was positive for malignant cells. She treated with IT chemotherapy and died 3 months after diagnosis of CM. A 48 year-old woman in premenopausal states had a left axillary mass for last 4 months. After one year of followed up she complaints with refractory headache. In cerebrospinal fluid (CSF) analysis with diagnosis of CM treated with brain irradiation and multiple courses of IT chemotherapy. After six months she is well still and in follow up with previo...
Neurology Research International, 2013
Introduction. Leptomeningeal carcinomatosis occurs in about 5% of cancer patients. Ocular involvement is a common clinical manifestation and often the presenting clinical feature. Materials and Methods. We report the case of a 52-year old lady with optic neuritis as isolated manifestation of neoplastic meningitis and a review of ocular involvement in neoplastic meningitis. Ocular symptoms were the presenting clinical feature in 34 patients (83%) out of 41 included in our review, the unique manifestation of meningeal carcinomatosis in 3 patients (7%). Visual loss was the presenting clinical manifestation in 17 patients (50%) and was the most common ocular symptom (70%). Other ocular signs were diplopia, ptosis, papilledema, anisocoria, exophthalmos, orbital pain, scotomas, hemianopsia, and nystagmus. Associated clinical symptoms were headache, altered consciousness, meningism, limb weakness, ataxia, dizziness, seizures, and other cranial nerves involvement. All patients except five underwent CSF examination which was normal in 1 patient, pleocytosis was found in 11 patients, increased protein levels were observed in 16 patients, and decreased glucose levels were found in 8 patients. Cytology was positive in 29 patients (76%). Conclusion. Meningeal carcinomatosis should be considered in patients with ocular symptoms even in the absence of other suggestive clinical symptoms.
Meningeal carcinomatosis as the initial manifestation of lymphoma
Journal of Negative and No positive Results, 2022
Introduction: Leptomeningeal carcinomatosis (LC) is diagnosed in 4-15% of cancer patients, and most cases (70%) are in the advanced phase of the disease. In only 5-10% of patients with LC, it is the initial manifestation of cancer. Case report: We present a case of a 46-year-old man with leptomeningeal carcinomatosis as the first manifestation of type B highgrade lymphoma. Cerebrospinal fluid (CSF) showed pleocytosis with a predominance of mononuclear cells, hyperproteinorrhachia, and glucose consumption. CSF cytology was negative for malignant cells in two samples. Magnetic resonance imaging and CSF flow cytometry gave the diagnosis. Discussion: LC is a diagnostic challenge. Differential diagnosis arises with infectious processes (tuberculosis) and autoimmune diseases. In cerebrospinal fluid, flow cytometry (FCM) has a higher sensitivity than cytology for the diagnosis of LC.
Nepal Journal of Neuroscience, 2019
Chronic meningitis is the inflammation of meanings having varied clinical manifestations and diverse etiologies. Among them tuberculosis continues to be an important cause of chronic meningitis. To achieve the etiological diagnosis, examination of cerebrospinal fluid is mandatory. Carcinomatous meningitis, another rare cause of chronic meningitis is caused by infiltration of leptomeninges by malignant cells. Diagnostics old standard of carcinomatous meningitis is to demonstrate malignant cells in the cerebrospinaluid. In cerebrospinal fluid negative cases with high degree of suspicion, various biomarkers may assist to arrive at diagnosis. However examination of single sample, delayed processing and low volume cerebrospinal fluid analysis may give rise to false negative results. Were port a patient of breast carcinoma presenting with intractable headache misdiagnosed as tuberculosis meningitis. Definitive diagnosis of carcinomatous meningitis was established by repeated lumbar punctu...
Infectious Diseases and Tropical Medicine (IDTM), 2017
— Introduction: Tuberculoma limited to the meninges as a result of mycobacterium tuberculosis infection is very rare and few cases have been reported on this clinical entity. Although some authors have described solitary forms of this presentation, no one reported a case on this diffuse occurrence. This diffuse pattern made the lesions mimic leptomeningeal gliomatosis on imaging studies. — Case presentation: We present a case of a 72-years old man with a two (2) months history of right lower limb weakness and slurred speech which he initially did not take into a great deal of consideration. He had no cough, fever or chills, syncopal episodes. He has a past medical history of splenectomy and cholecystectomy as a result of a car accident 8 years before. Contrast enhanced MRI performed at our facility showed left diffused temporo-parieto-occipital meningeal thickening with multiple parenchymal nodules. — Conclusions: Leptomeningeal tuberculomas should be suspected in patients who present with diffuse lesions of meninges although solitary or multiple forms of this kind of presentation frequently occur. The progress of the lesions or pathology from the time of first contact with mycobacterium depends on the immune response of the patient as well as the number and type of virulent strains involved. Open surgical biopsy to confirm the diagnosis is a very critical diagnostic step. The main treatment option is anti-TB medication and patients must be followed for a long time with series of imaging studies.