Prognostic Markers and Histologic Subtypes in Patients with Meningeal Carcinomatosis in Breast Cancer

Abstract

Objective: Meningeal carcinomatosis (MC) is a rare complication in breast cancer patients. It is defined as a diffuse or multifocal leptomeningeal metastasis. Study Design: From our institution database, we retrospectively studied 19 patients diagnosed with MC in the cerebrospinal fluid (CSF) in 1997-2015, in order to evaluate tumor prognostic markers, histologic subtypes, and clinical outcome. Results: All patients were female, with a mean age of 53 years (range 36-75 years). The mean interval between diagnosis of breast carcinoma and MC was 28 months (range 6-62 months). The median survival from the time of diagnosis was 2 months (1-51 months). Sixteen cases (84%) were the ductal phenotype, 62% of which were of a high grade (grade 3), and 3 cases (16%) were lobular. Estrogen and progesterone receptors were positive on immunohistochemistry (IHC) in 53 and 33% of patients, respectively. HER2 IHC was positive (3+) in 20% of the cases; all were amplified by fluorescence in situ hybridization. The incidence of MC in triple-negative tumors was 40%. Twelve patients (63%) already had known metastasis at the time of diagnosis. Conclusions: Most cases of MC are high-grade ductal. MC is more common in triple-negative breast cancers. The outcome of these breast cancer patients with MC was poor. There was no survival difference according to age, histologic subtype, grade, or hormonal or HER2 status.

Rare sites of breast cancer metastasis: a review

“…Interestingly, Zebrowski et al ( 407 ) suggested a potential association between the inability of trastuzumab to cross the blood-brain barrier and the occurrence of intramedullary metastases in Her2 positive disease. Additionally, some studies report a predisposition of lobular histotype to leptomeningeal carcinomatosis, whilst in the case of ductal carcinoma spreading to the meninges a high histological grade and triple-negative biology seems to be prevalent ( 394 ).…”

Leptomeningeal Metastasis: A Review of the Pathophysiology, Diagnostic Methodology, and Therapeutic Landscape

“…Breast cancer remains one of the leading cancer types by diagnosis, and cases have been steadily rising over the past decades [ 17 ]. While meningeal carcinomatosis (MC) is a rare metastatic outcome occurring in roughly 1–5% of solid tumors, primary breast tumors, along with lung tumors and melanoma, make up the most common origin sites [ 18 ]. Among studies of patients with leptomeningeal breast cancer metastasis (LBM), the average age of breast cancer diagnosis is often between 50 and 60 [ 18 , 19 , 20 , 21 , 22 , 23 ].…”

“…While meningeal carcinomatosis (MC) is a rare metastatic outcome occurring in roughly 1–5% of solid tumors, primary breast tumors, along with lung tumors and melanoma, make up the most common origin sites [ 18 ]. Among studies of patients with leptomeningeal breast cancer metastasis (LBM), the average age of breast cancer diagnosis is often between 50 and 60 [ 18 , 19 , 20 , 21 , 22 , 23 ]. Once diagnosed, the average time to develop LBM is less than 10 years [ 19 , 23 ].…”

“…Unfortunately, survival after leptomeningeal metastasis remains poor. Over multiple reviews and meta-analyses, the average survival time ranges from 16 weeks to 2 years [ 18 , 19 , 20 , 24 , 25 , 26 , 27 ].…”