Leptomeningeal Carcinomatosis From Carcinoma of Unknown Primary in a Young Patient: A Case Report and a Literature Review

Moosavi, Leila; D’Assumpcao, Carlos; Bowen, Jon; Heidari, Arash; Cobos, Everardo

doi:10.1177/2324709619869380

Cited by 2 publications

(3 citation statements)

References 29 publications

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“…With the importance of CSF rising in hematopoietic primary tumors, it may reveal pleocytosis, increased protein content, and hypoglycorrhachia. It is described as a gold standard confirmatory test, with serial sample testing having a specificity of more than 95% [ 1 , 3 ]. More often, MRI and CSF are used concurrently to complement the diagnosis of LC (66%-76% higher compared with a single LP) [ 3 , 4 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is described as a gold standard confirmatory test, with serial sample testing having a specificity of more than 95% [ 1 , 3 ]. More often, MRI and CSF are used concurrently to complement the diagnosis of LC (66%-76% higher compared with a single LP) [ 3 , 4 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Malignant cells, which proliferate into the leptomeninges, occur more commonly with hematological malignancies and less frequently with solid tumors, with an incidence of 5%-15% and 5%-8%, respectively [ 1 ]. Among the reported solid tumors that were associated with LC, cancer of unknown primary, breast cancer, lung cancer, and melanoma were the most reported [ 3 ]. Nevertheless, LC has been documented to be related to many systemic cancer types, including cancer of the ovary, fallopian tube, cervix, prostate, urinary bladder, gallbladder, stomach, and kidney and cutaneous melanoma [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Neurology Case Report: Rapidly Progressive Dementia and Extrapyramidal Symptoms as the First Presentation of Leptomeningeal Carcinomatosis

Alhubayshi¹,

Alasmari²,

Almahdi³

et al. 2022

Cureus

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Leptomeningeal carcinomatosis (LC) is a rare complication of primary malignancy that spreads to leptomeninges and cerebrospinal fluid (CSF). Due to its rarity, it is often diagnosed as a late complication of an advanced tumor. This report presents a case study of a 72-year-old nonsmoking female with multiple comorbidities with two-week rapidly progressive cognitive decline and extrapyramidal symptoms (EPS). She presented with speech difficulties, tension headaches, and episodes of inattention. On examination, she had a masked face, mild bradykinesia, mild rigidity more apparent in the limbs than axially, and slight hyperreflexia in the lower limbs with a normal plantar reflex (down-going). Magnetic resonance imaging (MRI) of the brain with gadolinium showed diffuse leptomeningeal dissemination. CT of the right lower lobe showed lobe apical segment mass lesion with air bronchogram extension to the hilum, which raised the suspicion that the patient had lung cancer. The microscopic analysis of cerebrospinal fluid (CSF) cytology showed poorly differentiated malignant cells favoring adenocarcinoma. Based on these investigations, leptomeningeal dissemination on the MRI led to a wide differential diagnosis; however, given the findings in the CT scan and CSF, the patient was diagnosed with leptomeningeal carcinomatosis secondary to metastatic lung cancer. Although LC is a rare terminal complication that presents with a wide range of symptoms, typically including headache, altered mental status, diplopia, back pain, cerebral signs, and leg weakness, our patient presented with an uncommon presentation, which was EPS. Therefore, this case report highlights the importance of early detection of LC in any patient presenting with unspecific neurological manifestations.

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