Objectives: To assess the diagnostic value of bronchoalveolar lavage fluid (BALF) ferritin as a lung tumor marker by comparing serum and BALF ferritin concentrations in patients with peripheral lung cancer versus control subjects with benign lung disease, and to examine the theory of ferritin compartmentalization around the tumor area by comparing ferritin concentrations in serum and bilateral (affected and unaffected side) BALF in cancer patients. Methods: Four groups of patients were investigated: 10 control nonsmokers, 10 control smokers, 10 smokers with chronic obstructive pulmonary disease (COPD), and 22 patients with primary bronchogenic carcinoma. A bronchoalveolar lavage (BAL) was performed in all subjects (both sides in 13 oncological patients, one side in the others) and samples of BALF and blood were submitted to biochemical analysis. Results: As a lung tumor marker, BALF ferritin showed 54% sensitivity and 93% specificity and serum ferritin 22% sensitivity and 93% specificity. A significant difference was observed between the two sides in the cancer patients (p = 0.033), and between BALF ferritin from the affected side and COPD patients (p = 0.025). Greater differences were obtained when BALF ferritin in the affected side of cancer patients was compared with values in both control nonsmokers (p < 0.0001) and control smokers (p < 0.001). Conclusions: These findings seem to confirm the relative diagnostic value of BALF ferritin as a lung tumor marker and the theory of ferritin compartmentalization. However, further studies are required to clarify the relations between iron and ferritin on the one hand and inflammation, tumorigenesis and host response on the other.

Leptomeningeal carcinomatosis (LC), previously known as carcinomatous meningitis, is a devastating neurologic complication of cancer. LC is associated with major neurologic disability and high mortality and occurs in 3% to 34% of all cancer patients. 1,2 An increasing incidence of brain and leptomeningeal metastases has been reported 3 during the history of patients with human epidermal growth factor receptor 2 (HER2) -overexpressing breast cancer. This clinical condition is the result of the neurotropism of HER2-overexpressing breast cancer cells combined with the high antitumoral activity of systemic administrations of trastuzumab without preventive effect in the brain and leptomeninges since trastuzumab does not effectively reach the cerebrospinal fluid (CSF) when given intravenously. 4 Intrathecal (IT) administration of trastuzumab has been tested in some patients with HER2-positive breast cancer and with LC occurring after a systemic treatment. [5][6][7][8] Recently, tumor specimens from 3,807 patients with gastric cancer were centrally tested for HER2 status. The rate for HER2-positive gastric cancer was 22%, which is similar to the rate for HER2-positive breast cancer 9 and, for the first time, positive results of a phase III trial of the efficacy of trastuzumab were reported for gastric cancer. 9,10 We report here the case of a patient with HER2-overexpressing gastric cancer who developed LC, and we demonstrated the HER2-positive status of malignant cells in the CSF. To the best of our knowledge, this is the first case report of LC in HER2-positive gastric cancer.A 77-year-old woman who was previously well complained of abdominal discomfort, anorexia, fatigue, and weight loss for the past 6 months. She was admitted to the Oncology-Hematology Department of the Hospital of Piacenza in Piacenza, Italy, on August 3, 2009, after she developed a disseminated intravascular coagulation (DIC). General physical examination revealed pallor, diffuse cutaneous hemorrhage with ecchymoses and petechiae, no adenopathy, and no hepatosplenomegaly. Laboratory tests revealed anemia with a hemoglobin level of 7 g/dL and a reduction in the platelet count to 5,000/mL. Other laboratory tests (prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin split products, and D-dimer) were consistent with the diagnosis of DIC.Abdominal ultrasound revealed the presence of small lymphadenopathies in the perigastric region; computed tomography (CT) scan of the chest was unremarkable, although a CT scan of the abdomen confirmed the findings of the ultrasound test: perigastric lymphadenopathies 2 cm in diameter. Gastroscopy with biopsy revealed gastric adenocarcinoma. A bone marrow biopsy was performed that demonstrated metastasis from gastric cancer. The immunohistochemistry