Leptomeningeal Carcinomatosis Originated from Breast Cancer

Abstract

Malignant melanoma, breast cancer and lung cancer are the most causative malignancies of leptomeningeal carsinomatosis (LC). A LC case that was previously diagnosed as tuberculosis meningitis, is presented here to emphasize the importance of maintaining a broad differential diagnosis in patients applied to the hospital with meningeal irritation symptoms. A 35-year-old woman was suffering from a severe headache and photophobia. Physical examination revealed nuchal rigidity but Kernig’s and Brudzinski signs were negative. Cerebrospinal fluid (CSF) findings were 171 cells/mm3 (lymphocytic predominance), elevated protein levels, decreased glucose. Atypical cells were detected in CSF cytology. The result of breast biopsy was in accordance with breast lobular carcinoma nuclear grade III. LC, usually developes in patients who have a known primary malignancy. As it occured in our case; in up to 10%-20% of cases, however, symptoms caused by LC may emerge before the diagnosis of the primary tumor. It should remember that meningitis may not be always infectious originated. J Microbiol Infect Dis 2015;5(3): 133-136

Key words: leptomeningeal carcinomatosis, meningitis, cerebrospinal fluid cytology

Keywords

• leptomeningeal carcinomatosis, meningitis, cerebrospinal fluid cytology

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Öz

Meme kanseri, akciğer kanseri ve malign melanom leptomeningeal karsinomatosize (LK) neden olan en sık malignitelerdir. Meningeal iritasyon bulguları olan hastalarda geniş ayırıcı tanı yapılmasının önemini vurgulamak için, tüberküloz menenjit ön tanısı almış bir LK olgusu sunulmuştur. Ciddi başağrısı ve fotofobi yakınması olan otuz beş yaşında kadın hastanın fizik muayenesinde ense sertliği vardı fakat Kernig-Brudzinsky belirtisi negatifti. Serebrospinal sıvı (BOS) analizinde, 171 hücre/mm3(lenfosit baskın) artmış protein seviyesi, azalmış glukoz saptandı. BOS sitolojisinde atipik hücreler görüldü. Meme biyopsisinin sonucu nükleer grade 3 meme lobüler karsinomu ile uyumluydu. LK, genellikle bilinen primer malignitesi olan hastalarda rastlanır. Bizim vakamızda olduğu gibi, vakaların % 10-20’sinde primer tümörün tanısı konulmadan önce LK’e sekonder gelişen semptomlar ortaya çıkabilir. Menenjitin her zaman enfeksiyöz orjinli olmayabileceği unutulmamalıdır

Anahtar Kelimeler

• leptomeningeal karsinomatozis, menenjit, serebrospinal sıvı sitolojisi

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