A Fulminant Case of Leptomeningeal Carcinomatosis Secondary to Esophageal Adenocarcinoma
| Autor: | Oktar Asoglu, Banu Tasci Fresko, Burcin Batman, Meltem Topalgokceli Selam, Hatice Tuzlali |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Esophageal Neoplasms Physical examination Neurological examination Adenocarcinoma Fourth ventricle 03 medical and health sciences 0302 clinical medicine medicine Cerebellar edema Humans Neoplasm Staging medicine.diagnostic_test business.industry Cranial nerves Gastroenterology Cauda equina Middle Aged medicine.disease Prognosis Surgery Hydrocephalus Meningeal carcinomatosis medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology business Meningeal Carcinomatosis |
| Zdroj: | Journal of gastrointestinal cancer. 47(1) |
| ISSN: | 1941-6636 |
| Popis: | A 46-year-old male patient presented with a 1-month history of solid food dysphagia and accompanying weight loss. His family history was negative. His physical examination was normal. A distal 1/3 esophageal mass was found on endoscopy and PET CT. He received 3 cycles of chemotherapy consisting of docetaxel, cisplatin, and capecitabine prior to his operation. He complained of tinnitus during this period, which was attributed to a side effect of chemotherapy. He was operated 1 month after the chemotherapy. Pathology revealed a moderately differentiated lymphadenopathypositive adenocarcinoma (T3 N3 M0). His chemotherapy was initiated post-operatively; he received 2 cycles of docetaxel, carboplatin, and capecitabine. The patient was admitted to the emergency department 2 months after the operation, with complaints of severe headache, facial numbness, generalized aches, back pain, and walking difficulties. He had nuchal rigidity, bifacial weakness, and moderate semi-symmetric quadriparesis more prominent in the lower extremities on his neurological examination. Deep tendon reflexes were absent, plantar reflexes equivocal. The patient presented a cranial MRI obtained the day before admission, which revealed subpial cerebellar parenchymal edema, diffuse and nodular leptomeningeal contrast enhancement of the cerebral sulci, cerebellar folia, basal cisterns and hypothalamic region, fourth ventricle and aquaductal compress ion with secondary hydrocephalus and transependymal CSF flow and bilateral II, V, VII, and VIIIth cranial nerves contrast enhancement. Analgesic therapy was initiated with parenteral paracetamol and fentanyl patch 25 mcg/h. The patient was given 100 mg IM tramadol 4 h later. The patient developed confusion and somnolence 2 h following the tramadol injection. A complete neuraxis MRI was obtained 10 h after the emergency department admission. Anesthesia was performed with sevoflurane and propofol during the procedure. The patient did not wake up after anesthetic discontinuation. The patient was admitted to the ICU. He had total areflexia on examination. The cranial MRI revealed increased periventricular edema, effacement of the basal cisterns, increased cerebellar edema, cerebral sulci and cerebellar folia effacement, and multiple contrast-enhancing lesions of the thalami and the hypothalamus (Figs. 1, 2, and 3). The spinalMRI revealed diffuse spinal cord and cauda equina enhancement. The patient developed diabetes insipidus during his stay in the ICU. He died on the 7th day. The family did not give consent for an autopsy. * Banu Tasci Fresko banutascifresko@yahoo.com |
| Databáze: | OpenAIRE |
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