Meningeal carcinomatosis from transitional cell carcinoma of the bladder

Eng, Charis; Cunningham, David; Quade, Bradley J.; Schwamm, Lee; Skarin, Arthur T.

doi:10.1002/1097-0142(19930715)72:2<553::aid-cncr2820720236>3.0.co;2-z

Cited by 29 publications

(9 citation statements)

References 8 publications

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“…A case report from Dana-Farber Cancer Institute summarised eight cases of patients with urothelial cancer with spread to the brain parenchyma or meninges 3. Of the eight patients reported, two presented with neurological symptoms of headache or mental status change and one presented with hypertension.…”

Section: Discussionmentioning

confidence: 99%

Leptomeningeal carcinomatosis as primary presentation of metastatic urothelial cancer

Lambird

Beerepoot

2018

BMJ Case Reports

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Leptomeningeal spread of carcinoma, referred to here as leptomeningeal carcinomatosis, is an uncommon complication of many cancer types. Its manifestations as the presenting symptoms of a new cancer diagnosis is even less common. This case describes the manifestations of leptomeningeal spread of urothelial carcinoma with review of pathophysiology driving the presenting symptoms of hypertension and headache. In the Discussion section, we address the standard and novel interventions for management of increased intracranial pressure.

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Section: Discussionmentioning

confidence: 99%

Leptomeningeal carcinomatosis as primary presentation of metastatic urothelial cancer

Lambird

Beerepoot

2018

BMJ Case Reports

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“…Carcinomatous meningitis is rare in bladder cancer [14]-[16]. Trastuzumab does not cross the blood–brain barrier [17], suggesting that targeting Her2/ neu positive systemic disease may alter the natural history of bladder carcinoma metastasis predisposing to the onset and progression of central nervous system (CNS) disease.…”

Section: Discussionmentioning

confidence: 99%

Carcinomatous meningitis in a patient with Her2/neu expressing bladder cancer following trastuzumab and chemotherapy: a case report and review of the literature

et al. 2009

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IntroductionTargeted therapies may impact the natural history of bladder cancer based upon their pharmacokinetics. The Her2/neu receptor tyrosine kinase, overexpressed by half of all primary urothelial carcinomas, has recently been examined as a therapeutic target in bladder cancer in a prospective phase II multicenter trial (NCI-198) that enrolled 109 patients with advanced bladder carcinomas for treatment with trastuzumab in combination with paclitaxel, carboplatin, and gemcitabine. We report on documented isolated Her2/neu positive carcinomatous meningitis in a patient treated with trastuzumab.Case presentationA 61-year-old Caucasian man with metastatic bladder cancer was treated with neoadjuvant chemotherapy in combination with trastuzumab with a partial response that was followed by a complete response after surgery. He relapsed with isolated Her2/neu positive carcinomatous meningitis.ConclusionCarcinomatous meningitis in bladder cancer is extremely rare. This is the first case reported of Her2/neu positive carcinomatous meningitis. Disease recurred solely at a sanctuary site, demonstrating that despite the systemic efficacy of trastuzumab in combination with chemotherapy, its inability to enter the central nervous system potentially contributes to the unusual site of disease recurrence.

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“…With prolonged survival, intraparenchymal brain metastases may occur in as many as 12% of patients who received methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) chemotherapy. 5 In the series by Bishop et al, 6 two of 17 patients treated with MVAC had carcinomatous meningitis.…”

Section: Muscle Invasive Bladder Cancer Culminating With Leptomeningementioning

confidence: 97%

Muscle invasive bladder cancer culminating with leptomeningeal carcinomatosis

Swallow

Mabbutt

Bell

2015

CUAJ

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This case reports highlights a rare metastatic manifestation of transitional cell carcinoma of the bladder. The onset of symptoms associated with meningeal irritation should be investigated. However, there is little consensus in the treatment of leptomeningeal carcinomatosis and it should be considered a poor prognostic sign with symptomatic management. Case reportA 51-year-old woman with a history of G3 pT4 transitional carcinoma of the bladder previously treated with chemoradiotherapy, was admitted to hospital after feeling generally unwell for three days. Her recent history included deteriorating renal function associated with bilateral hydronephrosis managed with indwelling bilateral ureteric stents. No evidence of local tumour recurrence within the bladder was found at cystoscopy.Initial investigations showed an acute kidney injury with a creatinine of 822 µmol/L from a baseline of 190-200 µmol/L. She had bilateral loin tenderness. She was catheterized and placed on strict fluid balance. An urgent ultrasound scan showed bilateral hydronephrosis. She was scheduled for an urgent cystoscopy and stent change.On induction of anesthesia, the patient suffered a grand mal seizure that self-terminated after less than five minutes. The procedure went ahead and both stents were successfully replaced. Postoperatively, the patient was taken to intensive care for hemofiltration and ventilation. An immediate postoperative computed tomography (CT) scan of the head was reported as normal. Her postoperative urine output was adequate, but she was slow to wean.She was stepped down to the ward on Day 7 post-admission and she started complaining of photophobia and neck stiffness. However, there were no other focal neurological signs and a medical review felt that meningitis was unlikely.Day 10 post-admission, the patient experienced left arm weakness that resolved on its own within an hour.In view of the clinical picture, a neurology opinion was sought. Magnetic resonance imaging (MRI) scan of the brain and a lumbar puncture was recommended. The MRI report suggested that appearances are highly suspicious of a meningeal pathology, either infection or metastatic disease. MRI with contrast was organized the next day to help differentiate between the two (Fig.1). The report concluded that the images are consistent with leptomeningeal carcinomatosis with mild hydrocephalus (Fig. 2).The results of the cerebral spinal fluid analysis were inconclusive; no malignant cells were found on cytology and there was no evidence of infection or xanthochromia.The patient was started on dexamethasone 8 mg. After discussion among the local multidisciplinary team, she was referred to the palliative care team for further care. She was discharged to the local hospice and died eight days later of metastatic cancer. DiscussionBladder cancer is the ninth most common cancer diagnosis worldwide, with more than 330 000 new cases each year and more than 130 000 deaths per year.1 The most common sites for metastatic spread are lymphatics and lungs. The...

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Meningeal carcinomatosis from transitional cell carcinoma of the bladder

Cited by 29 publications

References 8 publications

Leptomeningeal carcinomatosis as primary presentation of metastatic urothelial cancer

Leptomeningeal carcinomatosis as primary presentation of metastatic urothelial cancer

Carcinomatous meningitis in a patient with Her2/neu expressing bladder cancer following trastuzumab and chemotherapy: a case report and review of the literature

Muscle invasive bladder cancer culminating with leptomeningeal carcinomatosis

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