An unusual case of leptomeningeal carcinomatosis in a patient with primary adenocarcinoma of the lung

Abstract

A 72-year-old man was brought to the emergency department with acute onset confusion and haemoptysis. Chest X-ray showed a possible lung mass, while CT head showed a fluid-filled, space-occupying lesion (SOL) in the right frontal lobe of the brain. MRI head indicated that this SOL had spilt its contents into the subarachnoid and intraventricular spaces. Due to a fluctuating Glasgow Coma Scale (GCS), the patient underwent emergency debulking. Macroscopically, a frail-walled cystic tumour filled with straw-coloured fluid was noted; histology confirmed metastasis from a primary lung adenocarcinoma. Whole brain radiotherapy was given, with a view to commence systemic therapy. The patient, however, deteriorated and unfortunately passed away a few weeks after completing radiotherapy. This patient presented with leptomeningeal metastasis as the first presentation of a lung adenocarcinoma, and had a highly unusual mechanism by which leptomeningeal spread had occurred, with metastatic brain tumour spilling its contents into the meningeal spaces.

Carcinomatous Meningitis due to Ovarian and Gastric Cancers: Case Report and Literature Review on the Therapeutic Approach to this Rare Cancer Complication

“…The evolution under this treatment was marked by a significant deterioration of the patient's clinical condition leading to the discontinuation of all treatments after 4 intrathecal injections, followed by death, 2 months after the diagnosis. [2,4]. In general, carcinomatous meningitis is rare, complicating 5-10% of solid tumors [2,3].…”

“…The physiopathological principle of leptomeningeal metastases follows the classical pattern of metastatic dissemination of cancers. Indeed, the cancer cells by disseminating by haematogenous, lymphatic, perineural, or anatomical contiguity routes reach the subarachnoid space from where they disseminate into the cerebrospinal fluid [3,4,6]. Meningeal spread may also be iatrogenic during neurosurgical procedures such as resection of brain metastases [5].…”

Neurology Case Report: Rapidly Progressive Dementia and Extrapyramidal Symptoms as the First Presentation of Leptomeningeal Carcinomatosis

“…Leptomeningeal carcinomatosis (LC), or carcinomatous meningitis or leptomeningeal metastasis, is a rare and late-stage complication of a locally advanced or malignant tumor, which metastasis to leptomeninges and cerebrospinal fluid (CSF) [ 1 , 2 ]. Malignant cells, which proliferate into the leptomeninges, occur more commonly with hematological malignancies and less frequently with solid tumors, with an incidence of 5%-15% and 5%-8%, respectively [ 1 ].…”

“…Nevertheless, LC has been documented to be related to many systemic cancer types, including cancer of the ovary, fallopian tube, cervix, prostate, urinary bladder, gallbladder, stomach, and kidney and cutaneous melanoma [ 4 ]. The clinical presentation of LC depends on the location of involvement, so the disease causes a wide range of nonspecific manifestations [ 2 ]. Signs and symptoms are usually related to meningeal irritation, cranial and spinal nerve dysfunction, and increased intracranial pressure [ 1 ].…”

“…Some patients may also develop multiple cranial neuropathies or rapidly progressive dementia [ 1 ]. The diagnosis of LC is challenging and requires a high index of suspicious by the clinicians [ 2 ]. The diagnosis often requires a combination of magnetic resonance imaging (MRI) of the brain and spine and cerebrospinal fluid analysis with cytology [ 1 ].…”