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ABSTRACT Objective To evaluate whether intrathecal chemotherapy improves clinical outcomes in patients with meningeal carcinomatosis. Methods This retrospective cohort study included consecutive patients with breast cancer diagnosed with meningeal carcinomatosis. Clinical and treatment data were collected from the patients' medical charts. The primary outcome was overall survival, and the secondary outcomes were time to neurological deterioration and reporting of clinical benefit. Logistic regression and Cox proportional hazard models adjusted for potential confounders were used to evaluate the clinical response and overall survival, respectively. Results Overall, 109 female patients were included, 50 (45.9%) of whom received intrathecal chemotherapy with methotrexate and dexamethasone. The median treatment duration was 3 weeks (range, 1-13 weeks). Patients treated with intrathecal chemotherapy were more likely to report clinical benefit (74% versus 57.7%, adjusted odds ratio [OR] = 9.0, 95%CI=2.6-30.9, p<0.001). However, there was no difference in the time to neurologic deterioration (hazard ratio [HR] = 0.96, 95%CI= 0.57-1.59, p=0.86). Patients who received intrathecal chemotherapy did not show an increase in overall survival compared with that of patients who did not receive intrathecal chemotherapy (median overall survival = 1.8 months, 95%CI= 1.27-3.0 versus 2.5, 95%CI= 1.9-3.9, adjusted HR = 0.71, 95%CI= 0.41-1.22, p=0.21). There was a significant interaction between intrathecal chemotherapy and systemic treatment, and patients who received systemic therapy without intrathecal chemotherapy had better overall survival than that of the no-treatment group (adjusted HR = 0.38, 95%CI= 0.20-0.70, p=0.002). Conclusion Intrathecal chemotherapy did not increase overall survival or time to neurological deterioration and should not preclude or postpone systemic treatments.
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Resumen La carcinomatosis meníngea es una entidad poco frecuente, que puede formar parte de la historia natural de muchos procesos neoplásicos. Se presenta habitualmente con síntomas poco específicos, como cefalea, cambios en la conducta o alteraciones motoras y sensitivas. A continuación, presentamos el caso de una paciente con carcinomatosis meníngea por melanoma metastásico y su evolución clínica.
La carcinomatosis meníngea es una entidad poco frecuente, que puede formar parte de la historia natural de muchos procesos neoplásicos. Se presenta habitualmente con síntomas poco específicos, como cefalea, cambios en la conducta o alteraciones motoras y sensitivas. A continuación, presentamos el caso de una paciente con carcinomatosis meníngea por melanoma metastásico y su evolución clínica.
Subject(s)
Humans , Female , Aged , Skin Neoplasms/pathology , Meningeal Carcinomatosis/secondary , Melanoma/pathology , Fatal OutcomeABSTRACT
ABSTRACT Background: Intrathecal chemotherapy is a local therapeutic modality used for treatment of leptomeningeal metastases. However, the techniques currently used, i.e. repeated lumbar puncture and Ommaya reservoir, have certain disadvantages. Lumbar intrathecal port (LIP) placement is a relatively novel technique, which has been used for pain management in cancer patients. Objective: To investigate the use of LIP for intrathecal administration of chemotherapeutic agents in patients with leptomeningeal metastases. Methods: Retrospective study of 13 patients treated with intrathecal chemotherapy for secondary leptomeningeal involvement of a primary solid tumor were included in this retrospective study. The patients received intrathecal chemotherapy through a LIP. Results: The patients received a total of 123 intrathecal chemotherapy doses. No grade 3-4 toxicity, technical problem or severe complication developed. During a median of 136 days of follow-up (range, 67-376 days), 12 patients died (92.3%). The treatment resulted in symptom improvement in all patients and self-rated overall health and quality of life improved, compared with baseline. Conclusions: The LIP system, which has been used for intrathecal pain management for decades, appears to offer a safe alternative for intrathecal chemotherapy in patients with leptomeningeal metastases. Further studies are warranted to clarify its potential use in this setting.
RESUMEN Antecedentes: La quimioterapia intratecal es una modalidad terapéutica local utilizada para el tratamiento de metástasis leptomeníngeas. Sin embargo, las técnicas empleadas actualmente, es decir, las punciones lumbares repetidas y el depósito de Ommaya, tienen algunos inconvenientes. La colocación de un puerto intratecal lumbar (LIP) es una técnica relativamente nueva que se ha utilizado para el tratamiento del dolor en pacientes con cáncer. Objetivo: Investigar el uso de LIP para la administración intratecal de agentes quimioterapéuticos en pacientes con metástasis leptomeníngeas. Métodos: Este estudio retrospectivo incluyó un total de 13 pacientes tratados con quimioterapia intratecal por afectación leptomeníngea secundaria de un tumor sólido primario. Los pacientes recibieron quimioterapia intratecal a través de un LIP. Resultados: Los pacientes recibieron un total de 123 dosis de quimioterapia intratecal. No se desarrolló toxicidad de grado 3-4, ni se presentaron problemas técnicos o complicaciones graves. Durante un promedio de 136 días de seguimiento (rango, 67-376 días), murieron 12 pacientes (92,3 %). El tratamiento dio como resultado una mejoría de los síntomas en todos los pacientes. La salud general autoevaluada y la calidad de vida mejoraron en comparación con los valores iniciales. Conclusiones: El sistema LIP que se ha utilizado para el manejo del dolor intratecal durante décadas, parece ofrecer una alternativa segura para la quimioterapia intratecal en pacientes con metástasis leptomeníngeas. Serán necesarios más estudios para determinar su uso potencial en este ámbito.
Subject(s)
Humans , Meningeal Carcinomatosis/drug therapy , Meningeal Neoplasms/drug therapy , Antineoplastic Agents/therapeutic use , Quality of Life , Retrospective StudiesABSTRACT
OBJECTIVE: The purpose of this pilot study was to examine the safety and function of the newly developed cerebrospinal fluid (CSF) reservoir called the V-Port.METHODS: The newly developed V-Port consists of a non-collapsible reservoir outlined with a titanium cage and a connector for the ventricular catheter to be assembled. It is designed to be better palpated and more durable to multiple punctures than the Ommaya reservoir. A total of nine patients diagnosed with leptomeningeal carcinomatosis were selected for V-Port insertion. Each patient was followed up for evaluation for a month after the operation.RESULTS: The average operation time for V-Port insertion was 42 minutes and the average incision size was 6.6 cm. The surgical technique of V-Port insertion was found to be intuitive by all neurosurgeons who participated in the pilot study. There was no obstruction or leakage of the V-Port during intrathecal chemotherapy or CSF drainage. Also, there were no complications including post-operative intracerebral hemorrhage, infection and skin problems related to the V-Port.CONCLUSION: V-Port is a safe and an easy to use implantable CSF reservoir that addresses problems of other implantable CSF reservoirs. Further multicenter clinical trial is needed to prove the safety and the function of the V-Port.
Subject(s)
Humans , Catheters , Cerebral Hemorrhage , Cerebrospinal Fluid , Drainage , Drug Therapy , Intracranial Pressure , Meningeal Carcinomatosis , Neurosurgeons , Pilot Projects , Punctures , Skin , TitaniumABSTRACT
Objective To explore the diagnostic value of cytologic examination of cerebrospinal fluid (CSF) combined with cell immunochemical staining examination in the patients with meningeal carcinomatosis in the clinical track.Methods CSF was centrifuged and precipitated using the StatSpin Cytofuge 12 centrifuge. It was dyed by the May-Grunwald-Giemsa Staining (MGG) method and cell immunochemical staining (S-P method). Clinical data of 16 cases with the diagnosis of meningeal carcinomatosis were retrospectively analyzed. Results Sixteen patients diagnosed meningeal carcinomatosis prior to imaging findings in 11 of 16 patients were diagnosed meningeal carcinomatosis through the cerebrospinal fluid cytology combined with cell immunochemical staining prior to imaging findings. CSF cytology observed the cancer cell pleomorphism. Cell immunochemical staining examination clearly distinguished classification organic source of meningeal carcinomatosis. Conclusions CSF cytology combined with cell immunochemical staining examination is one of the important means in tracking intracranial metastatic tumor in clinic.
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OBJECTIVE: The purpose of this pilot study was to examine the safety and function of the newly developed cerebrospinal fluid (CSF) reservoir called the V-Port. METHODS: The newly developed V-Port consists of a non-collapsible reservoir outlined with a titanium cage and a connector for the ventricular catheter to be assembled. It is designed to be better palpated and more durable to multiple punctures than the Ommaya reservoir. A total of nine patients diagnosed with leptomeningeal carcinomatosis were selected for V-Port insertion. Each patient was followed up for evaluation for a month after the operation. RESULTS: The average operation time for V-Port insertion was 42 minutes and the average incision size was 6.6 cm. The surgical technique of V-Port insertion was found to be intuitive by all neurosurgeons who participated in the pilot study. There was no obstruction or leakage of the V-Port during intrathecal chemotherapy or CSF drainage. Also, there were no complications including post-operative intracerebral hemorrhage, infection and skin problems related to the V-Port. CONCLUSION: V-Port is a safe and an easy to use implantable CSF reservoir that addresses problems of other implantable CSF reservoirs. Further multicenter clinical trial is needed to prove the safety and the function of the V-Port.
Subject(s)
Humans , Catheters , Cerebral Hemorrhage , Cerebrospinal Fluid , Drainage , Drug Therapy , Intracranial Pressure , Meningeal Carcinomatosis , Neurosurgeons , Pilot Projects , Punctures , Skin , TitaniumABSTRACT
PURPOSE: In this retrospective study, we compared the incidence of leptomeningeal carcinomatosis or dural metastasis (LMCDM) in patients who received whole brain radiotherapy (WBRT), partial radiotherapy (PRT), or no radiotherapy (RT) following resection of brain metastases from breast cancer. MATERIALS AND METHODS: Fifty-one patients with breast cancer underwent surgical resection for newly diagnosed brain metastases in two institutions between March 2001 and March 2015. Among these, 34 received postoperative WBRT (n=24) or PRT (n=10) and 17 did not. RESULTS: With a median follow-up of 12.4 months (range, 2.3 to 83.6 months), 22/51 patients developed LMCDM at a median of 8.6 months (range, 4.8 to 51.2 months) after surgery. The 18-months LMCDM-free survival (LMCDM-FS) rates were 77.5%, 30.0%, and 13.6%, in the WBRT, PRT, and no RT groups, respectively (p=0.013). The presence of a tumor adjacent to cerebrospinal fluid flow and no systemic treatment after treatment for brain metastases were also associated with poor LMCDM-FS rate. Multivariate analysis showed that WBRT compared to PRT (p=0.009) and systemic treatment (p < 0.001) were independently associated with reduced incidence of LMCDM. CONCLUSION: WBRT improved LMCDM-FS rate after resection of brain metastases compared to PRT in breast cancer patients.
Subject(s)
Humans , Brain , Breast Neoplasms , Breast , Cerebrospinal Fluid , Follow-Up Studies , Incidence , Meningeal Carcinomatosis , Multivariate Analysis , Neoplasm Metastasis , Radiotherapy , Retrospective StudiesABSTRACT
PURPOSE: In this retrospective study, we compared the incidence of leptomeningeal carcinomatosis or dural metastasis (LMCDM) in patients who received whole brain radiotherapy (WBRT), partial radiotherapy (PRT), or no radiotherapy (RT) following resection of brain metastases from breast cancer. MATERIALS AND METHODS: Fifty-one patients with breast cancer underwent surgical resection for newly diagnosed brain metastases in two institutions between March 2001 and March 2015. Among these, 34 received postoperative WBRT (n=24) or PRT (n=10) and 17 did not. RESULTS: With a median follow-up of 12.4 months (range, 2.3 to 83.6 months), 22/51 patients developed LMCDM at a median of 8.6 months (range, 4.8 to 51.2 months) after surgery. The 18-months LMCDM-free survival (LMCDM-FS) rates were 77.5%, 30.0%, and 13.6%, in the WBRT, PRT, and no RT groups, respectively (p=0.013). The presence of a tumor adjacent to cerebrospinal fluid flow and no systemic treatment after treatment for brain metastases were also associated with poor LMCDM-FS rate. Multivariate analysis showed that WBRT compared to PRT (p=0.009) and systemic treatment (p < 0.001) were independently associated with reduced incidence of LMCDM. CONCLUSION: WBRT improved LMCDM-FS rate after resection of brain metastases compared to PRT in breast cancer patients.
Subject(s)
Humans , Brain , Breast Neoplasms , Breast , Cerebrospinal Fluid , Follow-Up Studies , Incidence , Meningeal Carcinomatosis , Multivariate Analysis , Neoplasm Metastasis , Radiotherapy , Retrospective StudiesABSTRACT
Objective To study the clinical features, laboratory results and image characteristics of meningeal carcinomatosis (MC). Methods The clinical data, laboratory and image results, and cerebrospinal fluid (CSF) findings of 29 cases diagnosed as MC were retrospectively reviewed and analyzed. Results Lung cancer is more common as the primary malignancy in MC patients [16(55.2%)]. The earliest neurological symptoms varied in MC patients, and headache was the most common symptom (58.6%), followed by epilepsy (13.8%), vision loss (10.3%), neuralgia (6.8%), hearing loss (6.8%) and hoarseness (3.4%), and a part of MC patients presented some serious complications. Examination of CSF of MC patients revealed an increase in intracranial pressure, and the presence of white blood cells, red blood cells and increased protein content, while the contents of glucose and chlorides decreased.The content of carcinoembryonic antigen (CEA) increased obviously, and CSF cytological exam was found to be positive in 26% patients. Head CT may not helpful for the diagnosis of the MC. The enhanced brain MRI scanning may reveal abnormal enhancement of piamater in 94.7% of MC patients, with diffuse enhancement in 94.4% of cases occurring mostly in piamater and subarachnoid space. Conclusions MC is an unique form of brain metastases of malignant tumor.The clinical feature are varied and lack of specificity. Enhanced brain MRI scanning and CSF examination may provide some value for diagnosis.Meningeal metastasis is one of the most critical complications resulting in high mortality. Early diagnosis of MCfollowed by enhanced treatment can prolong survival time and improve patients' prognosis.
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We describe a case of meningeal carcinomatosis of the internal auditory meatus presenting as sudden deafness accompanied by dizziness. A 54-year-old woman complained of acute right-side hearing loss in October 2014. The pure tone audiometry test revealed right-side hearing loss of 47.5 dB. She was treated with oral steroids. Her hearing as well as her symptoms of dizziness worsened and she was admitted for further examination. Her right and left-side hearing had worsened to 105.0 dB and 47.5 dB, respectively. A magnetic resonance imaging scan of the head revealed bilateral enhancement of the internal auditory canal and multiple brain metastases. The chest radiograph revealed a mass in the left lung. Adenocarcinoma of the lung was diagnosed. Lumbar puncture yielded no evidence of carcinoma cells in the cerebrospinal fluid, but an increased number of lymphocytes was confirmed. A diagnosis of multiple brain metastases and leptomeningeal metastasis from the adenocarcinoma of the lung was considered. Whole-brain radiation therapy (30 Gr/10 fractions) was administered. Progressive bilateral hearing loss is a rare first manifestation of meningeal carcinomatosis. It is quite important to consider the possibility of this condition when patients present with sudden deafness.
Subject(s)
Female , Humans , Middle Aged , Adenocarcinoma , Audiometry , Brain , Cerebrospinal Fluid , Diagnosis , Dizziness , Ear, Inner , Head , Hearing , Hearing Loss , Hearing Loss, Bilateral , Hearing Loss, Sudden , Lung , Lymphocytes , Magnetic Resonance Imaging , Meningeal Carcinomatosis , Neoplasm Metastasis , Radiography, Thoracic , Spinal Puncture , Steroids , Temporal BoneABSTRACT
Objective To evaluate the performance of high-fluorescence body fluid cell (HF-BF)mode on the platform Sysmex XE-5000 automated blood analyzer,and analyse its clinical application value in diagnosis of meningeal carcinomatosis.Methods E-valuated the performance of HF-BF by using precision test and methodology comparison test.Retrospectively analyzed 295 test re-sults of cerebrospinal fluid in Zhongshan Hospital Affiliated to Xiamen University from June 2010 to September 2012.Results HF-BF on the platform Sysmex XE-5000 automated blood analyzer had high precision,and exhibited a good consistency with cytolgical examination.The percentage of high-fluorescence body fluid cell(HF-BF%)in the meningeal carcinomatosis group was higher than that in other cerebral diseases groups,had statistically significant differences (P < 0.05 ).The cut-off value for HF-BF% was 4.3%,while the area under a receiver operating characteristic (ROC)curve (AUC)was 0.933,the sensitivity was 95.2%,and the specificity was 92.7%.When HF-BF% was over 4.3%,it was more likely to detect tumor cell in cerebrospinal fluid cytology.Con-clusion HF-BF is an effective reference index for the early diagnosis of meningeal carcinomatosis and has significant clinical appli-cation value.
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PURPOSE: The aim of this study is to investigate the clinical features and outcomes of 9 consecutive patients who suffered with leptomeningeal carcinomatosis (LMC) originating from gastric cancer. METHODS: Between January 1995 and December 2010, we retrospectively reviewed the medical records of 9 patients with gastric LMC who had been treated at St. Vincent's Hospital, The Catholic University of Korea. RESULTS: With the exception of 1 patient, the primary gastric cancer was Borrmann type III or IV, and 5 cases had poorly differentiated or signet ring cell histology. TNM stage of the primary gastric cancer was III in 6 patients. The median interval from diagnosis of the primary malignancy to the diagnosis of LMC was 9 months. Headache (6 cases), altered mental status (4 cases), and dysarthria (3 cases) were presenting symptoms of LMC. Computed tomography findings were abnormal in 4 of 7 cases, while magnetic resonance imaging revealed abnormality in 4 of 5 cases. Radiation therapy was administered to 5 patients and intrathecal chemotherapy was administered to only 1 patient. Median overall survival duration from the diagnosis of LMC was 3 months. CONCLUSION: LMC originating from gastric cancer had a fatal clinical course and treatment strategies remain challenging.
Subject(s)
Humans , Diagnosis , Drug Therapy , Dysarthria , Headache , Korea , Magnetic Resonance Imaging , Medical Records , Meningeal Carcinomatosis , Neoplasm Metastasis , Prognosis , Retrospective Studies , Stomach NeoplasmsABSTRACT
Gastric cancer is one of the most common causes of cancer-related death in Asian countries, including Korea. We experienced a case of leptomeningeal carcinomatosis (LC) from gastric cancer that was originally misdiagnosed as vestibular schwannoma based on the similar radiological characteristics. To our knowledge, LC from gastric cancer is very rare. In conclusion, our experience with this case suggests that clinicians should consider the possibility of delayed leptomeningeal metastasis when treating patients with gastric cancer.
Subject(s)
Humans , Asian People , Carcinoma, Signet Ring Cell , Korea , Meningeal Carcinomatosis , Neoplasm Metastasis , Neurofibromatoses , Neuroma, Acoustic , Stomach NeoplasmsABSTRACT
Leptomeningeal metastasis (LMM), also referred to as leptomeningeal carcinomatosis, results from diffuse infiltration of the leptomeninges by malignant cells originating from extra-meningeal primary tumors. It occurs in approximately 5%-10% of patients with solid tumor. Among solid tumors, the most common types leading to infiltration of the leptomeninges are breast cancer, lung cancer, and melanoma. Patients with LMM may present various signs and symptoms. Herein, we report a rare case with initial presentation of isolated chest wall pain. Computed tomography of the chest with contrast revealed a 2.5-cm nodule over the left upper lung. Biopsy confirmed the diagnosis of adenocarcinoma. Later, cerebrospinal fluid cytology exam also confirmed leptomeningeal seeding. It is rare for leptomeningeal carcinomatosis patients to present with chest wall pain. Therefore, a high index of suspicion is mandatory for accurate and prompt diagnosis.
Subject(s)
Humans , Adenocarcinoma , Biopsy , Breast Neoplasms , Cerebrospinal Fluid , Chest Pain , Diagnosis , Lung , Lung Neoplasms , Melanoma , Meningeal Carcinomatosis , Neoplasm Metastasis , Thoracic Wall , ThoraxABSTRACT
Introdução: O sarcoma de Ewing representa 10% dos tumores ósseos, com predomínio no sexo masculino. A maior incidência é dos 5 aos 14 anos. Acomete mais as extremidades e em 25% dos casos há metástases ao diagnóstico. O acometimento do sistema nervoso central ocorre em 3% dos pacientes. A infiltração das leptomeninges é rara e ocorre predominantemente por contiguidade de uma lesão óssea subjacente. Relato do caso: Mulher de 27 anos com lesão em tíbia direita de 17 cm. A biópsia diagnosticou sarcoma de Ewing. Estadiamento sistêmico foi negativo e planejada quimioterapia neoadjuvante com esquema VAC-IE para preservação do membro. Após o primeiro ciclo de VAC teve neutropenia precoce, infecção de sítio tumoral, sepse e síndrome compartimental do membro. Submetida a amputação suprapatelar. Após 30 dias apresentou paralisia do VII, VI e III pares cranianos à esquerda e VII e III à direita, tomografia computadorizada do crânio foi normal e o líquor confirmou infiltração meníngea. A paciente evoluiu a óbito três dias após o diagnóstico de metástase meníngea. Discussão: A literatura é escassa em informações sobre a frequência do envolvimento meníngeo no sarcoma de Ewing. A forma peculiar do acometimento neste caso, sem metástase óssea que invadisse o sistema nervoso por contiguidade, faz-nos concluir que tal disseminação ocorreu pela via hematogênica. A paciente apresentava fatores de mau prognóstico (tumor > 100ml, idade > 26 anos, intervalo diagnóstico-metástases < 2 anos). O acometimento meníngeo contribuiu para o desfecho desfavorável, pois é um local de difícil controle da doença, considerado um santuário.
Subject(s)
Humans , Female , Adult , Neoplasm Metastasis/diagnosis , Neoplasm Metastasis/pathology , Sarcoma, Ewing/complications , Sarcoma, Ewing/diagnosis , Sarcoma, Ewing/mortalityABSTRACT
PURPOSE: Neoplastic meningitis (NM) is diagnosed by the presence of malignant cells within cerebrospinal fluid (CSF), or brain and spinal cord imaging with magnetic resonance imaging (MRI). Patients with NM were divided into three diagnostic subcategories, and overall survival as a function of diagnostic modalities was analyzed. METHODS: A total of 150 patients with a solid tumor or lymphoma diagnosed as NM in an emergency department between 2003 and 2010 were included. Patients were divided into three groups: positive cytology and MRI (n=64), positive cytology with negative MRI (n=43), and negative cytology with positive MRI (n=43). RESULTS: Overall median survival from NM was eight weeks. CSF was positive for malignant cells in 107(71.3%) patients, and MRI was positive in 107(71.3%) patients. Survival did not vary significantly among the three groups [CSF(+), MRI(-): median 12 weeks, range 1-80(95% CI, 7-17); CSF(-), MRI(+): median 12 weeks, range 1-66 (95% CI, 7-17); CSF(+), MRI(+): median 6 weeks, range 1-64(95% CI, 3-9), p=0.306]. CONCLUSION: When considering diagnostic modalities, examination of CSF and MRI showed the same sensitivities, and the survival of NM was similar in patients with different diagnostic modalities.
Subject(s)
Humans , Brain , Emergencies , Lymphoma , Magnetic Resonance Imaging , Meningeal Carcinomatosis , Meningitis , Spinal CordABSTRACT
Allogeneic hematopoietic stem cell transplantation (HSCT) is considered the optimal curative treatment for acute myeloid leukemia (AML), but some patients develop bone marrow relapse due to remnant leukemia, and few patients develop extramedullary relapse without bone marrow relapse. Isolated extramedullary relapse (IMER) is defined as extramedullary relapse without bone marrow relapse. IMER has been reported in various sites, including the skin, soft tissue, and central nervous system(CNS). Isolated CNS relapse is relatively rare and is associated with poor prognosis due to the absence of an optimal treatment for it. Reported herein is a case involving an adult AML woman who suffered from isolated extramedullary relapse in the CNS after allogeneic HSCT. She was treated with intrathecal chemotherapy and whole-brain and spine radiotherapy, followed by systemic chemotherapy. She is currently well, with no evidence of leukemia recurrence for over six years.
Subject(s)
Adult , Female , Humans , Bone Marrow , Bone Marrow Transplantation , Central Nervous System , Hematopoietic Stem Cell Transplantation , Hematopoietic Stem Cells , Leukemia , Leukemia, Myeloid, Acute , Meningeal Carcinomatosis , Prognosis , Recurrence , Skin , SpineABSTRACT
The involvement of the leptomeninges by metastatic tumors can be observed in solid tumors, in which case it is termed meningeal carcinomatosis (MC), and in lymphoproliferative malignant disease. It is more common in breast and lung cancer, as well as melanoma, with adenocarcinoma being the most frequent histological type. MC is usually a late event, with disseminated and progressive disease already present and, it is characterized by multifocal neurological signs and symptoms. Diagnosis is based on the evaluation of clinical presentation, cerebrospinal fluid and neuroimaging studies. The better systemic disease control is observed with new therapeutic agents, and the development of neuroimaging methods is responsible for the increasing incidence of such metastatic evolution. Intrathecal chemotherapy is generally the treatment of choice, although frequently palliative. Prognosis is guarded, although a higher performance status may indicate a subgroup of patients with a more favorable outcome.
O acometimento leptomeníngeo por metástases tumorais pode ocorrer em tumores sólidos, sendo chamado de carcinomatose meníngea (CM), e também em doenças linfoproliferativas. Tumores de mama, pulmão e melanoma são os principais responsáveis pelos casos, e adenocarcinoma é a histologia mais frequentemente encontrada. A CM é um evento tardio na evolução da doença e caracteriza-se por sinais e sintomas neurológicos multifocais. O diagnóstico se faz pela avaliação conjunta do quadro clínico, neuroimagem e estudo do líquido cefalorraquidiano. O maior controle da doença sistêmica obtido com as novas modalidades terapêuticas e a baixa penetração de drogas no sistema nervoso central, aliados ao desenvolvimento nos métodos de neuroimagem observado nas últimas décadas, são fatores que respondem por um aumento na incidência desta apresentação. A quimioterapia intratecal é o tratamento de escolha, porém, frequentemente paliativo. O prognóstico é reservado, sendo que o melhor performance status pode selecionar um subgrupo de pacientes com melhor evolução.
Subject(s)
Humans , Meningeal Carcinomatosis/diagnosis , Meningeal Carcinomatosis/therapy , Meningeal Carcinomatosis/secondary , PrognosisABSTRACT
Meningeal carcinomatosis in patients with prostate cancer is very rare. Recently, we experienced a case of meningeal carcinomatosis in a patient with prostate cancer. He had undergone a radical prostatectomy 11 years before presentation and had undergone chemotherapy 4 years before presentation due to bone metastases. This time, he visited the emergency department because of a seizure. Although cerebrospinal fluid (CSF) examinations did not reveal malignant cells, we diagnosed meningeal carcinomatosis based on positive CSF prostate-specific antigen and magnetic resonance imaging (MRI) findings. The diagnosis was confirmed pathologically. We treated the patient with whole brain radiotherapy and intrathecal chemotherapy. We report a case of prostate cancer with meningeal carcinomatosis with a literature review.