A rare case of meningeal carcinomatosis and internal auditory canal metastasis presenting with the deafness for gastric cancer

Abstract

Background Meningeal carcinomatosis is a very rare metastatic site of gastric cancer and meningeal carcinomatosis without other metastatic sites is much extremely rare. Herein, we report our experience with a very rare case of meningeal carcinomatosis which was difficult to diagnose the recurrence by general systemic examination and was found due to the deafness despite the sustained high tumor markers. Case presentation A 68-year-old man consulted a hospital with vomiting and hematemesis. Laboratory tests revealed severe anemia. He was referred to our hospital and underwent an emergency gastroscopy, which revealed Borrman type 3 tumor and oozing of blood. Biopsy specimen showed gastric cancer. After several examinations, total gastrectomy was performed and tegafur-gimeracil-oteracil potassium (S-1) was initiated as adjuvant chemotherapy one month after surgery. Tumor marker levels (CEA and CA19-9) remained high for three months after surgery. S-1 was continued while shortening the imaging study follow-up period. Nine months after surgery, he noticed difficulty in hearing with facial paralysis, dizziness, tinnitus, and appetite loss. He was diagnosed with meningeal carcinomatosis and bilateral internal auditory canal metastasis. He died approximately two months later. Conclusion Meningeal carcinomatosis should be considered if bilateral deafness and vestibulopathy develop after gastrectomy, even if no recurrence is apparent in the abdominal cavity.

Rare Manifestations of Gastric Cancer: Leptomeningeal Carcinomatosis Without Other Metastases

“…Meningeal carcinomatosis frequently coincides with metastasis in the gray white matter of the brain, leptomeningeal carcinomatosis, as well as distant metastasis in other organs. Hence, instances of meningeal carcinomatosis without concurrent metastases are extremely uncommon (15). The patient in this case developed LM without any clinical symptoms, con rming metastases to other sites, and MEGNETIC RESONANCE IMAGING (MRI) of the brain performed no paranshymal metastases except for leptomeningeal enhancement related to LM in ltration.…”

“…Gastric cancer is considered the fourth tumor and the second cause of death worldwide (15). The most frequent locations for metastases of gastric cancer include the liver, peritoneum, lymph nodes, lungs, and bones.…”

“…The most frequent locations for metastases of gastric cancer include the liver, peritoneum, lymph nodes, lungs, and bones. Meningeal carcinomatosis is an exceedingly uncommon site of metastasis for gastric cancer, occurring in only 0.1-0.69% of patients (15,16). In this case, a patient with gastric adenocarcioma performed symptoms related to LM, which is a rare manifestation as mentioned above.…”

Clinical Reasoning: A 72-Year-Old Woman With Rapidly Progressive Bilateral Hearing Loss

“…In a retrospective series, 6 of 12 patients had rapidly progressive hearing loss attributable to an intracranial lesion or systemic vasculitis 5 . Reported etiologies include viral or fungal meningitis, superficial siderosis, internal auditory metastasis, leptomeningeal metastasis, or paraneoplastic cochleovestibulopathy 2,5,6,7 . Therefore, it is essential for physicians to recognize and investigate this symptom thoroughly.…”

“…5 Reported etiologies include viral or fungal meningitis, superficial siderosis, internal auditory metastasis, leptomeningeal metastasis, or paraneoplastic cochleovestibulopathy. 2,[5][6][7] Therefore, it is essential for physicians to recognize and investigate this symptom thoroughly.…”