Leptomeningeal carcinomatosis as primary manifestation of pancreatic cancer
| Autor: | Rafael Medina-Flores, Victoria T. Trinh, Muhammad Omar Chohan |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Pathology Tuberculous meningitis Metastasis Diagnosis Differential 03 medical and health sciences 0302 clinical medicine Physiology (medical) Pancreatic cancer medicine Humans Meningitis business.industry Headache Aseptic meningitis General Medicine Middle Aged Metastatic Pancreatic Adenocarcinoma medicine.disease Magnetic Resonance Imaging Pancreatic Neoplasms Meningeal carcinomatosis Neurology 030220 oncology & carcinogenesis Surgery Neurology (clinical) Radiology Differential diagnosis business Meningeal Carcinomatosis 030217 neurology & neurosurgery |
| Zdroj: | Journal of Clinical Neuroscience. 30:124-127 |
| ISSN: | 0967-5868 |
| Popis: | Leptomeningeal carcinomatosis (LMC) is a rare complication of cancer that often presents at an advanced stage after obvious metastasis of a primary cancer or locally advanced disease. We present an uncommon case of LMC secondary to pancreatic carcinoma presenting with headache, unilateral VII nerve palsy, and lower extremity weakness. Initial cerebrospinal fluid (CSF) studies were concerning for chronic aseptic meningitis but negative for malignant cells; the diagnosis of tuberculous meningitis was erroneously evoked. Three lumbar punctures were required to capture malignant cells. The diagnosis of LMC was based on CSF examination with cytology/immunohistochemistry and leptomeningeal enhancement on MRI. Post mortem autopsy revealed advanced and diffusely metastatic pancreatic adenocarcinoma. This patient demonstrates that solid tumors can present with leptomeningeal spread that often confuses the treating physician. Fungal or tuberculous meningitis can mimic LMC in the absence of neoplastic signs and negative CSF cytology. This event is exceedingly rare in pancreatic cancer. If the index of suspicion is high, repeat CSF sampling can increase the sensitivity of detection of malignant cells and thus result in the correct diagnosis. |
| Databáze: | OpenAIRE |
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