Background The reported incidence of leptomeningeal carcinomatosis is 3–8% in patients with solid tumours. More commonly, it has been described in the setting of advanced cancers of the lung, breast and malignant melanoma. Case presentation A 50-year-old diabetic patient with recurrent unresectable squamous cell carcinoma (SCC) of the right retromolar trigone (rT4bN0M0) presented with severe low backache and weakness in bilateral lower limbs 20 days after the completion of concurrent chemoradiotherapy. Contrast-enhanced MRI of the spine showed multiple nodular enhancing leptomeningeal lesions at the lumbar level and an intramedullary T2/FLAIR-hyperintense longitudinal lesion involving the central cord from C2 to C7 vertebral levels, suggestive of leptomeningeal metastases. Cerebrospinal fluid (CSF) analysis revealed pleocytosis, elevated protein and markedly decreased glucose. The CSF cytology revealed scattered large atypical cells, suspicious for metastasis. Non-contrast MRI of the brain showed a T2/FLAIR-hyperintense lesion involving the right caudate nucleus suggestive of either an acute infarct with haemorrhagic transformation or a haemorrhagic brain metastasis. During assessment, he had high-grade fever and was started on empirical intravenous antibiotics (ceftriaxone, vancomycin and subsequently meropenem) in line with the management for acute bacterial meningitis. Gram staining of CSF did not demonstrate the presence of any bacteria and the specimen was sterile on culture. He did not respond to empirical antibiotics, had a progressive downhill course and eventually died due to aspiration pneumonia. Conclusion This brief report highlights the importance of awareness of leptomeningeal carcinomatosis as a possible cause of backache with sensorimotor deficit and autonomic dysfunction in a previously treated case of head and neck SCC.
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e16607 Background: Gallbladder cancer (GBC) is one of the three leading cancer among women of North and North-east India. The age standardized rate (ASR) for GBC in women of North and north-east India are 11.8/100,000 population and 17.1/100,000 population respectively It is one of the most fatal cancer, characterized by early spread, both local as well as distant. Radical resection is associated with the highest control rates. Presence of inter-aorto-caval lymph nodes (IAC) during preoperative workup is designated as metastatic disease in GBC and radical surgery is deferred. This study attempts to confirm the validity of such an approach. Methods: Between January 2017 and December 2018, 178 patients of GBC were registered at our hospital. Of these, 108 patients with radiologically resectable disease were evaluated preoperatively with endoscopic ultrasound (EUS) to look for IAC lymph nodes lying below the level of the renal vein. Patients with IAC involvement were taken up for chemotherapy while the others underwent upfront surgery. Results: Mean age at presentation was 51.1 (±10.9) years with a female predominance (N = 77, 71.2%). Presenting symptoms were either pain (N = 91, 84.2%) or jaundice (N = 42, 38.8%) in majority cases. Patients with jaundice presented earlier with mean of 53.27 days (Range2-240 days) while those with pain presented at a mean of 71.5 days (1-360 days) prior to diagnosis. Pathologically positive IAC cases (n = 12) of resectable GBC received systemic therapy upfront rather than immediate radical surgery. Rest of the patients underwent surgical resection followed by adjuvant treatment as indicated. Mean follow up was 179 days with a mortality of 62%(n = 67). No significant difference was seen in the stage distribution in IAC positive versus negative group. Median survival with Kaplan Meier method of IAC positive patients was 239 days versus 190 days in IAC negative patients. Conclusions: IAC lymph node may not necessarily portend poor prognosis. It needs to be validated in large sample size.
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