Leptomeningeal Carcinomatosis: A Rare Complication of Metastatic Gastric Cancer

Abstract

Leptomeningeal disease, also known as leptomeningeal carcinomatosis, occurs when cancer metastasizes to the meninges. This rare complication is associated with a poor prognosis. It is most commonly seen in patients with metastatic breast cancer, lung cancer, and melanoma. However, it is extremely rare in patients with metastatic gastric cancer.A 64-year-old female with poorly differentiated gastric adenocarcinoma metastatic to the peritoneum developed new neurological symptoms twelve months after initiating palliative chemotherapy. Her uptrending tumor markers, brain magnetic resonance imaging (MRI) findings, and lumbar puncture results were consistent with leptomeningeal disease. The patient was started on treatment with intrathecal methotrexate (IT MTX), which resulted in significant improvement in her neurological symptoms.Leptomeningeal disease in gastric cancer has limited treatment options due to poor blood-brain barrier penetration. IT MTX is a potentially effective treatment for patients with leptomeningeal disease from gastric cancer.

Leptomeningeal Carcinomatosis and Brain Metastases in Gastroesophageal Carcinoma: a real-world analysis of Clinical and Pathologic Characteristics and Outcomes

“…Brain metastasis is rare complication from esophageal and gastric cancer and our study showed an incidence over than 3%, while the average incidence in the literature ranges from 0.7% -6.6% (3,4,5,6,7,23). Leptomeningeal disease is even more rare with only few cases in the literature and the prevalence is estimated to be between 0.16% and 0.19% of gastric cancers [10], slightly lower than our study, 0.61%.…”

“…Brain metastasis (BrM) and leptomeningeal carcinomatosis (LMC) are rare complications associated with gastroesophageal carcinoma (GEC). The occurrence of BrM ranges from 0.7% to 6.6% [3][4][5][6][7][8][9], while the incidence of LMC varies between 0.16% and 0.19% [10]. The complications are associated with neurologic morbidity and poor prognosis and quality of life [11], with median survival historically reported to be in the range of 2 to 6 months after its diagnosis [3][4][5][6][7][8].…”

“…Treatment of brain metastasis and leptomeningeal carcinomatosis is challenging because most systemic chemotherapeutics in use have limited permeability across the blood brain barrier [15][16]. Therefore, treatment of brain metastasis relies on surgical resection and/or radiotherapy as treatment modalities and leptomeningeal carcinomatosis, on whole brain radiation therapy and, in selected cases, intrathecal chemotherapy [8][9][10].…”

Leptomeningeal Carcinomatosis: A Rare Presentation of Perforated Gastric Cancer

“…About 1%-8% of cancer patients in the United States are diagnosed with LMC [ 8 ]. LMC is a rare occurrence with gastric cancers but has been reported to be associated with 0.16%-0.19% of gastric cancers [ 10 ]. The most common subtype of gastric cancer associated with LMC is poorly differentiated adenocarcinoma with signet ring cell features [ 11 ].…”

A Case of Leptomeningeal Carcinomatosis Manifesting With Vertigo in the Setting of Intracranial Hypertension

“…LMC occurs in 5-8% of patients with systematic malignancy [7,8]. Breast cancer has been considered the leading cause of LMC accounting for 11-64% of the overall incidence of LMC in solid tumors, followed by lung cancer (14-29%) and melanoma (6-18%) [9][10][11][12].…”