Leptomeningeal metastases

Demopoulos, Alexis

doi:10.1007/s11910-004-0039-z

Cited by 46 publications

(31 citation statements)

References 53 publications

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“…analysis. A number of different biological markers such as lactate dehydrogenase (LDH) and b-glucuronidase have been proposed (2). However, the lack of sensitivity and specificity of these analytes limits their use in diagnostic practice.…”

Section: Discussionmentioning

confidence: 99%

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Intrathecal synthesis of tumor markers is a highly sensitive test in the diagnosis of leptomeningeal metastasis from solid cancers

Corsini

Bernardi

Gaviani

et al. 2009

Clinical Chemistry and Laboratory Medicine

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Background: Identification of neoplastic cells in cerebrospinal fluid (CSF) by cytological analysis is the key diagnostic feature of leptomeningeal metastasis (LM). Because of the lack of sensitivity of this test, considerable efforts have been made to identify alternative diagnostic markers. Data from the literature suggest that measurement of tumor markers (TM) in CSF may be helpful for improving the diagnosis. Methods: We analyzed the concentrations of the TM carcinoembryonic antigen (CEA), CA15.3, CA125 and CA19.9 in both CSF and serum from 18 patients with neoplastic meningitis diagnosed by CSF cytology. We also performed these same measurements in 50 patients affected by other neurological diseases (OND) in order to evaluate putative intrathecal synthesis. In addition, CSF and serum concentrations of the proangiogenic factor VEGF (vascular endothelial growth factor) were evaluated. Results: All LM patients showed intrathecal synthesis for at least one TM. In one patient, a negative CSF cytology after treatment paralleled normalization of tumor marker synthesis. None of the OND patients displayed intrathecal TM synthesis. The VEGF Index (CSF/serum VEGF relative to CSF/serum albumin ratios) was significantly higher in LM patients compared with the control group. However, significant overlap between LM patients and values seen in those with OND was observed. Conclusions: Evaluation of intrathecal TM synthesis is a specific, sensitive, reliable, and reproducible diagnostic tool, and is useful to support diagnosis of carcinomatous meningitis. Clin Chem Lab Med 2009;47:874-9.

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Section: Discussionmentioning

confidence: 99%

“…According to autopsy studies, LM occurs in 5%-8% of cancer cases. However, the incidence is increasing and is probably due to more effective therapies and better diagnostic tools (1,2). Although LM is a late complication in most patients, in 5%-10% it is the first manifestation of cancer (3).…”

Section: Introductionmentioning

confidence: 99%

Intrathecal synthesis of tumor markers is a highly sensitive test in the diagnosis of leptomeningeal metastasis from solid cancers

Corsini

Bernardi

Gaviani

et al. 2009

Clinical Chemistry and Laboratory Medicine

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“…As a result, micrometastases grow and become clinically evident months to years later, while the systemic disease continues in remission [3]. Therefore, although most leptomeningeal metastases occur in widely disseminated and progressive systemic cancer [4], it is not unusual that leptomeningeal metastases cause neurological function impairment in a cancer patient, particularly from breast carcinoma, which is found to have multifocal signs on the neurological examination and has no evidence of systemic disease [5].…”

Section: Leptomeningeal Metastasesmentioning

confidence: 99%

Metastatic disease of the brain: extra-axial metastases (skull, dura, leptomeningeal) and tumour spread

2004

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Extra-axial intracranial metastases may arise through several situations. Hematogenous spread to the meninges is the most frequent cause. Direct extension from contiguous extra-cranial neoplasms, secondary invasion of the meninges by calvarium and skull base metastases, and migration along perineural or perivascular structures are less common. Leptomeningeal invasion gives rise to tumour cell dissemination by the cerebrospinal fluid (CSF), eventually leading to neoplastic coating of brain surfaces. Contrast-enhanced magnetic resonance (MR) imaging is complementary to CSF examinations and can be invaluable, detecting up to 50% of false-negative lumbar punctures. MR findings range from diffuse linear leptomeningeal enhancement to multiple enhancing extra-axial nodules, obstructive communicating and non-communicating hydrocephalus. Both calvarial and epidural metastases infrequently transgress the dura, which acts as a barrier against tumour spread. Radionuclide bone studies are still a valuable screening test to detect bone metastases. With computed tomography (CT) and MR, bone metastases extending intracranially and primary dural metastases show the characteristic biconvex shape, usually associated with brain displacement away from the inner table. Although CT is better in detecting skull base erosion, MR is more sensitive and provides more detailed information about dural involvement. Perineural and perivascular spread from head and neck neoplasms require thin-section contrast-enhanced MR.

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“…(14) Small cell lung cancer and myeloblastic leukaemia are more likely to spread to meninges. (15) Neurolymphomatosis (NL) (16) seen in three of our patients is characterized by infiltration of malignant lymphocytes into the peripheral nervous system particularly the cranial nerves, spinal nerve roots, brachial/lumbar plexus, and/or peripheral nerves. It is a rare neurological manifestation (0.8-2.5%).…”

Section: Localization Of Lesion In the Nervesmentioning

confidence: 96%

A Clinical Study of Multiple Cranial Neuropathies (Mcn)

G¹,

Ramesh²,

Suma³

et al. 2016

jemds

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BACKGROUNDCranial neuropathies are frequently seen by neurologist. The causes are many and evaluation presents a unique challenge for the diagnostician. The differential diagnosis is broad and includes infections, inflammatory conditions, cavernous sinus lesions, and many life-threatening processes like neoplastic meningitis A knowledge of the anatomy of the cranial nerves and their involvement in pathologic processes is therefore one of the corner stones of neurologic diagnosis. Just as with any other neurologic presentation, the first step in the evaluation requires correct localization. Processes affecting multiple cranial nerves may involve intramedullary structures of the brainstem as well as their extramedullary course. The majority of the literature regarding aetiologies of multiple cranial neuropathies consists of case reports or small case series with very few reported large series. The largest reported series to date of multiple cranial neuropathies was that of Keane.

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Leptomeningeal metastases

Cited by 46 publications

References 53 publications

Intrathecal synthesis of tumor markers is a highly sensitive test in the diagnosis of leptomeningeal metastasis from solid cancers

Intrathecal synthesis of tumor markers is a highly sensitive test in the diagnosis of leptomeningeal metastasis from solid cancers

Metastatic disease of the brain: extra-axial metastases (skull, dura, leptomeningeal) and tumour spread

A Clinical Study of Multiple Cranial Neuropathies (Mcn)

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