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

Kaynakça

1. Tunkel AR, Beek DV, Scheld WM. Acute Meningitis. In: Mandell
2. GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7thed. Philadelphia, PA: Churchill Livingstone Elsevier 2009;1189-1229
3. Gripshover BM, Ellner JJ. Chronic meningitis syndrome and
4. meningitis of noninfective or uncertain etiology. In: Scheld WM, Whitley RJ, Durack DT, eds. Infectious of The Central Nervous System, 2nd ed. Philadelphia, PA: Lippincott-Raven Publishers 1997; 881-896.
5. Pavlidis N. The diagnostic and therapeutic management of
6. leptomeningeal carcinomatosis. Ann Oncol 2004;15:285-291.
7. Zachariah B, Zachariah SB, Varghese R, Balducci L. Carcinomatous
8. meningitis: clinical manifestations and management. Int J Clin Pharmacol Ther 1995; 33:7-12.

9. Scott BJ, Kesari S. Leptomeningeal metastases in breast cancer.
10. Am J Cancer Res 2013; 3:117-126.
11. Walkty A, Abbott B, Swirsky N, Safneck J, Embil JM. Keeping
12. an open mind about meningitis: a case report of carcinomatous
13. meningitis. CJEM 2011; 13:352-356.
14. Taillibert S, Laigle-Donadey F, Chodkiewicz C, Sanson M, Hoang-Xuan K, Delattre JY. Leptomeningeal metastases from solid malignancy: a review. J Neurooncol 2005; 75:85-99.
15. Hildebrand J, Aoun M. Chronic meningitis: still a iagnosticchallenge. J Neurol 2003; 250:653-660.
16. Grossman SA, Krabak MJ. Leptomeningeal carcinomatosis. Cancer Treat Rev 1999; 25:103-119.
17. DeMay RM. Cerebrospinal fluid. In: DeMay RM, Ed. The Art& Science Of Cytopathology, 2nd ed. Chicago, PA: ASCP 2012;490-534.
18. Balm M, Hammack J. Leptomeningeal carcinomatosis:
19. presenting features and prognostic factors. Arch Neurol 1996;53:626-632.
20. Glantz MJ, Cole BF, Glantz LK, et al. Cerebrospinal fluid
21. cytology in patients with cancer: minimizing false-negative
22. results. Cancer 1998; 82:733-739.
23. McNally ME, Carson W.Occult breast cancer presenting as
24. leptomeningal carcinomatosis. World J Oncol 2012; 3:73-77.