Leptomeningeal metastasis of pulmonary large-cell neuroendocrine carcinoma: A case report and review of the literature

Yang, Guozi; Pan, Zhenyu; Ma, Ning; Qu, Limei; Yuan, Tingting; Pang, Xiaochuan; Yang, Xu; Dong, Lihua; Liu, Shixin

doi:10.3892/ol.2017.6676

Cited by 6 publications

(7 citation statements)

References 21 publications

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“…As concurrent diffuse multifocal intracranial LMs have been documented in more than half of our pooled cases, we emphasize the importance to include brain axis imaging in known metastatic patients with suspected spine lesions or in patients with newly diagnosed spine LMs (11,65). CSF cytologic analysis may be used to confirm the diagnosis of LMs by detecting pathological cellular lines similar to the primary tumors' ones (38,46,54,57,59). However, lumbar taps may be difficult to obtain, especially in patients with CSF obstruction, and negative CSF cytology may occur in up to 40% of patients with clinical and radiological diagnosis of LMs (6,65,69,73).…”

Section: Discussionmentioning

confidence: 99%

Leptomeningeal Metastases of the Spine: A Systematic Review

et al. 2022

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Background/Aim: Leptomeningeal metastases (LMs) of the spine have complex management. We reviewed the literature on spine LMs. Materials and Methods: PubMed, EMBASE, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA guidelines to include studies of spine LMs. Results: We included 46 studies comprising 72 patients. The most frequent primary tumors were lung (19.4%) and breast cancers (19.4%). Median time from primary tumors was 12 months (range=0-252 months). Cauda equina syndrome occurred in 34 patients (48.6%). Nodular spine LMs (63.6%) were more frequent. Concurrent intracranial LMs were present in 27 cases (50.9%). Cerebrospinal fluid cytology was positive in 31 cases (63.6%). Cases were managed using palliative steroids (73.6%) with locoregional radiotherapy (55.6%) chemotherapy (47.2%), or decompressive laminectomy (8.3%). Post-treatment symptom improvement (32%) and favorable radiological response (28.3%) were not different based on treatment (p=0.966; p=0.727). Median overallsurvival was 3 months (range=0.3-60 months), not significantly different between radiotherapy and chemotherapy (p=0.217). Conclusion: Spine LMs have poor prognoses. Radiotherapy, chemotherapy, and surgery are only palliative, as described for intracranial LMs.Leptomeningeal metastases (LMs) are late-stage complications of systemic malignancies, occurring approximately in 5-10% of patients with solid and hematologic neoplasms (1, 2). Frequently manifesting with new neurological deficits, LMs may be detected at T1-contrast MRI follow-ups as nodular or diffuse meningeal enhancement, and may be confirmed with high-volume cerebrospinal fluid (CSF) taps for cytology (3,4). Several systemic therapeutic options are available, but the treatment goal remains palliation, as mean survival ranges 3-6 months (3,5,6).LMs involving the spine represent unique entities that may severely impact patients' functional status (7, 8). While diffuse spinal LMs may remain clinically silent and go undetected, nodular spinal LMs frequently compress spinal nerve roots causing radicular pain or neurological impairments (2, 9). Nodular spinal LMs may also lead to acute or progressive cauda equina syndrome, which require urgent diagnosis and management (10,11). While surgical decompression may provide prompt symptomatic relief, patients may not be good candidates due to their significant tumor burden (2, 3). In these cases, locoregional radiation, chemotherapy, and other systemic treatments may be pursued to achieve similar clinical outcomes (12, 13).Although spinal LMs pose significant challenges in the oncological care of patients with systemic metastases, only 619 This article is freely accessible online.

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Section: Discussionmentioning

confidence: 99%

Leptomeningeal Metastases of the Spine: A Systematic Review

et al. 2022

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“…Fewer than 2% of patients with NETs experience metastatic brain disease [20], whereas 45% have metastases at any sites, with the most common locations being the regional lymph nodes, liver, lung, and bones. Metastases are most common in patients with neuroendocrine carcinoma and/or G3 NET [21].…”

Section: Discussionmentioning

confidence: 99%

“…Leptomeningeal metastasis is diagnosed in 5-15% of patients with solid cancer [22] and is most common in those with melanoma, breast cancer, or lung cancer [21]. Leptomeningeal metastasis of large-cell neuroendocrine carcinoma has been reported [21]. To our knowledge, no cases of leptomeningeal metastasis complicating low-grade (G1 or G2) NET have been described.…”

Section: Discussionmentioning

confidence: 99%

Contribution of Immune-Mediated Paraneoplastic Syndromes to Neurological Manifestations of Neuroendocrine Tumours: A Retrospective Study

et al. 2020

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Introduction: Neurological symptoms associated with neuroendocrine tumours (NETs) may be related to metastatic disease or paraneoplastic syndromes (PNSs); these last are often associated with autoantibodies targeting various onconeural antigens. To better characterize neurological PNSs related to NETs, we report the largest case-series study to date. Methods: We retrospectively reviewed the charts of all patients diagnosed with NETs of the gastrointestinal tract who presented with neurological symptoms at either of 2 tertiary academic hospitals (Henri Mondor and Beaujon, France) between 1994 and 2016. All patients underwent extensive neurological tests including clinical, laboratory, and radiological investigations. The clinical response to immunomodulating agents was recorded. Results: In the 13 identified patients, the most common presentations were peripheral neuropathy (46.2%) and encephalopathy (26.6%). Of the 6 (53.3%) patients whose serum anti-neuronal antibodies were assayed, 5 had high titres. Short-term oral corticosteroid and immunosuppressant drug therapy was given to 4 of these patients, of whom 3 had a clinical response and 1 no response. Repeated high-dose intravenous immunoglobulin therapy induced a complete clinical response in 1 patient. Encephalopathy resolved fully after hepatectomy or intrahepatic chemoembolization for liver metastases in another 2 patients. Discussion: The neurological symptoms associated with NETs may be due in part to autoimmune PNS. Based on experience at our 2 centres, we estimate that autoimmune PNS occurs in about 1% of patients with NETs. Early symptom recognition allows the initiation of effective treatments including corticosteroids, immunosuppressive drugs, and/or intravenous immunoglobulins.

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“…LCNEC with distant metastasis has a poor response to systemic chemotherapy [4], and the median survival of patients with distant metastasis is estimated to be approximately 6 months, with a five-year survival rate of 0% [5]. The common sites of metastasis from LCNEC are the liver, adrenal glands, bones and brain [6], but there are no previous reports of resection for metastasis of LCNEC. In our case, we performed hepatectomy for solitary liver metastasis from lung LCNEC, and there was no sign of recurrence 6 months after hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

“…LCNEC with distant metastasis has a poor response to systemic chemotherapy [4], and the life expectancy of the patient is estimated at approximately 6 months [5]. The common site of metastasis from LCNEC is the liver [6], but there are no previous reports of hepatectomy for liver metastasis of LCNEC. Herein, we present a case report to perform laparoscopic hepatectomy for liver metastasis from lung LCNEC.…”

Section: Introductionmentioning

confidence: 99%