A case of lung cancer with cranial neuropathy as the first sign of onset due to metastatic leptomeningeal carcinomatosis]

A 68-year-old man suffered right facial palsy and left deafness, however, his condition was considered to be idiopathic and he was followed. Three months later, bloody sputum and hoarseness caused him to be admitted to our hospital. An abnormal shadow was detected in the right upper lung field and adenocarcinoma of the lung with multiple brain metastases was diagnosed. He underwent gamma-knife radiosurgery for the brain lesions and subsequent systemic chemotherapy consisting of combined carboplatin and paclitaxel, which were not effective. Subsequently various neurological symptoms appeared, such as muscle weakness of the extremities, dizziness, and gait disturbance. Adenocarcinoma cells confirmed in the cerebrospinal fluid were similar to those in the obtained by transbronchial curetting. Whole-brain irradiation was performed, however, the neurological symptoms worsened and he died. Leptomeningeal carcinomatosis is difficult to diagnose while the patient is alive. It is thought that cranial neuropathy due to leptomeningeal carcinomatosis is a rare form of onset for lung cancer.     

Gastric adenocarcinoma with leptomeningeal carcinomatosis as the presenting manifestation: an autopsy case report

Leptomeningeal carcinomatosis is a clinically important and severe complication in patients with cancer. Leptomeningeal involvement as a secondary event in gastric carcinoma is rarely reported and usually occurs late in advanced disease. Herein, we report a case of leptomeningeal carcinomatosis as the initial manifestation of a previously asymptomatic gastric adenocarcinoma. The clinical features and the appropriate diagnostic procedures are discussed.     

Rare case of pancreatic cancer with leptomeningeal carcinomatosis

Leptomeningeal carcinomatosis occurs very rarely in patients with pancreatic cancer.Leptomeningealcarcinomatosis is characterized by multifocal seeding of the leptomeninges by malignant cells that originate from a solid tumor.To the best of our knowledge,brain metastasis from pancreatic cancer is extremely rare.Leptomeningeal carcinomatosis is estimated to occur in 3% to 8% of cases of solid tumors.The clinical manifestation usually involves neurological symptoms,including dizziness,headache,vomiting,nausea,and hemiparesis,symptoms similar to those of meningitis or brain tumors.Diagnostic methods for leptomeningeal carcinomatosis include brain magnetic resonance imaging and cerebrospinal fluid examination.Here,we describe a case of leptomeningeal carcinomatosis in which the primary tumor was later determined to be pancreatic cancer.Brain magnetic resonance imaging findings showed mild enhancement of the leptomeninges,and cerebrospinal fluid cytology was negative at first.However,after repeated spinal taps,atypical cells were observed on cerebrospinal fluid analysis and levels of tumor markers such as carbohydrate antigen 19-9 in cerebrospinal fluid were elevated.Abdominal computed tomography,performed to determine the presence of extracerebral tumors,revealed pancreatic cancer.Pancreatic cancer was confirmed histopathologically on examination of an endoscopic ultrasound-guided fine needle aspiration specimen.     

A case report of a patient with inoperable primary diffuse leptomeningeal melanomatosis treated with whole-brain radiotherapy and pembrolizumab

Rationale:Primary diffuse leptomeningeal melanomatosis (PDLM) is a rare disease that affects melanocytes in the leptomeninges. There is very limited data on the efficacy of immunotherapy in this setting.Patient concerns:A patient (23 years old) was diagnosed with PDLM. Histologically, atypical melanocytic cells were also observed.Diagnosis:Immunohistochemistry showed positivity for S100 protein, NKiC3, and vimentin, and negativity for Melan-A and HMB-45, with a proliferation index of 30%. Extracranial disease was excluded using dermatological and other examinations, including positron emission tomography/computed tomography with ¹⁸F-fluorodeoxyglucose.Interventions:The patient was treated with whole-brain radiotherapy (10 fractions to a total dose of 30 Gy) concomitantly with pembrolizumab and then continued with immunotherapy until disease progression with a maximum effect of partial remission on magnetic resonance imaging scans.Outcomes:Progression-free survival was 6.0 months and overall survival 6.5 months.Lessons:This is one of the few case reports of an adult patient with this rare malignancy being treated with a programmed death-1 inhibitor with partial response. Immunotherapy in metastatic PDLM may be a reasonable therapeutic option.     

Leptomeningeal carcinomatosis secondary to gastroesophageal adenocarcinoma: a case report and review of the literature.

BACKGROUND: Leptomeningeal carcinomatosis (LC) is a rare metastatic complication of solid tumours. It has been mainly described in association with breast cancer, lung cancer and melanoma. CASE PRESENTATION: A patient presenting with progressive solid food dysphagia with documented adenocarcinoma of the lower esophagus and gastroesophageal junction is reported. One month after the initial diagnosis, the patient developed gradual onset of increasing headache and progressive decrease in the level of consciousness. Computed tomography of the head showed evidence of meningeal enhancement, and cerebrospinal fluid examination showed the presence of adenocarcinoma cells, making the diagnosis of LC. The patient died one month after LC was diagnosed. DISCUSSION: LC is a poor prognostic sign in solid organ malignancies. It usually presents with headache, altered level of consciousness and focal neurological deficits. Diagnosis is established by finding malignant cells in the cerebrospinal fluid and supported by marked meningeal enhancement on computed tomography of the brain. A review of the English literature found only three reported cases of LC secondary to esophageal malignancy. CONCLUSION: A case of LC complicating esophageal and gastroesophageal junction malignancy is described. A high index of suspicion and early diagnosis may influence the poor outcome of these patients.     

A case of M. avium lung disease complicated with adenocarcinoma]

A 56-year-old man was admitted to our hospital for examination of an abnormal shadow found in a chest radiograph. Chest CT demonstrated a thick-walled cavity surrounded by small centrilobular nodules in the upper lobe of the left lung. Chemotherapy with rifampin, isoniazid, ethambutol and pyrazinamide was started, because acid-fast bacilli were observed in the bronchial brushing smear. Since PCR examination of the bronchial lavage was positive for M. avium, the rifampin and ethambutol were retained, while the other drugs were replaced with streptomycin and clarithromycin. However, in this case the radiographic findings did not point to non-tuberculous mycobacterial (NTM) infection, since the thickness of the cavity was irregular in the caudal portion. In addition, the patient did not accept long-term NTM therapy. Therefore, we chose surgical therapy. In a portion of the surgical specimen, adenocarcinoma was detected. The possibility of lung cancer should be remembered in cases with a thick-walled lung cavity.     

长期生存的晚期肺腺癌患者的个体化全程管理一例

<正>病例资料患者女性,68岁,焊工,因"间断发热伴右侧胸痛半月"于2009-06-18入院。半月前患者于受凉后出现畏寒、间断发热,最高体温39.4℃,伴右侧胸痛,呈间歇性隐痛,无咳嗽、咳痰、咯血、盗汗、胸闷、气促、纳差、腹痛、腹泻等。当地医院胸部CT示"双肺炎性病变,不除外其他",为求进一步诊治入我院。入院查体:右侧锁骨上可扪及一枚肿大淋巴结,约     

Long-term outcome after multidisciplinary approach for leptomeningeal carcinomatosis in a non-small cell lung cancer patient with poor performance status

The present study describes a case of a 60-year-old Japanese man who was histologically diagnosed with lung adenocarcinoma harboring L858R mutation of epidermal growth factor receptor. He was successfully treated with gefitinib, but eventually developed leptomeningeal carcinomatosis. He underwent ventriculoperitoneal shunting for hydrocephalus and received erlotinib in place of gefitinib with concurrent whole brain radiotherapy; this resulted in dramatic improvement in his symptoms and performance status from four to one and he survived for as long as 13.6 months after the initiation of erlotinib therapy. This multidisciplinary approach may be particularly useful in terms of increasing survival and improving quality of life.     

Multimodal approach and long-term survival in a patient with recurrent metastatic acinar cell carcinoma of the pancreas: A case report

Pancreatic acinar cell carcinoma is an uncommon neoplasm of the exocrine pancreas associated with a poor prognosis, especially when found to be metastatic. Since there are a lack of large studies and prospective, randomized data, no consensus treatment guidelines are available. Here, we report a case of a patient with recurrent metastatic acinar cell carcinoma involving the liver who had presented initially with pancreatic panniculitis. She received chemotherapy with capecitabine and oxaliplatin prior to resection of her primary tumor and liver metastases, after which she experienced a 30 months recurrence-free survival. Upon relapse, she was treated with a combination of capecitabine and oxaliplatin followed by maintenance capecitabine. Now, more than seven years after initial diagnosis, the patient remains stable without evidence of active disease. This case highlights the possibility of therapeutic success even for a patient initially deemed unresectable due to a poor performance status who responded to fluoropyrimidine-based therapy.     

A case of primary Sj?gren's syndrome complicated with lung adenocarcinoma]

A 69-year-old woman presented with headache. Her chest radiograph and computed tomographic scans showed a mass shadow causing superior vena cava syndrome. Bronchofiberscopic examination was nonproductive. The serum value of carcinoembryonic antigen was highly elevated, so we made a presumed diagnosis of primary non-small lung cancer. She also complained of dry eyes and mouth. The elevated values of serum antibodies against SS-A and SS-B and further examinations resulted in a definitive diagnosis of primary Sj?gren's syndrome. Chemotherapy was not effective and she died 14 months later. Autopsy revealed that the mass shadow was a primary lung adenocarcinoma. At the age of 66 she suffered a refractory pneumothorax and her pulmonary cysts or bullae were surgically resected. Those lesions had bullae, emphysema, and alveolar septae thickened by infiltration of lymphoplasmacytic cells. Because she had complained of xerostomia for the last few decades, we associated the cysts with Sj?gren's syndrome. Thoracic CT scans at that time showed a nodule next to a cystic lesion. We raise a possibility that lung cancer might derive from cystic lesions associated with Sj?gren's syndrome.     

A case of lung adenocarcinoma showing diffuse air-space consolidation with idiopathic interstitial pneumonia]

Routine chest radiography demonstrated abnormal opacities in the right lower lung field of a 54-year-old man with idiopathic interstitial pneumonia. A high-resolution chest CT scan showed diffuse air-space consolidation in the right lower lung with replacement of a honeycomb area. The diagnosis was adenocarcinoma, and a right lower lobectomy was performed. Histopathologic examination showed moderately differentiated adenocarcinoma and the pathological stage was T3 N0 M0 (Stage IIB). About 1 year later, the cancer recurred with diffuse air-space consolidation in the whole of the right lung and the left middle and lower lung, which resulted in the patient's death. It was difficult to discriminate between an acute change for the worse of idiopathic interstitial pneumonia and a recurrence of lung cancer on the basis of the CT findings in this patient. It is important to elucidate the CT features of lung cancer associated with idiopathic interstitial pneumonia.     

A case of primary lung cancer complicated with hypothyroidism by diffuse thyroid metastasis]

A 56-year-old woman with hypothyroidism was admitted to our hospital because of an abnormal chest X-ray film. The chest CT showed a 3-cm spiculated tumor in the left lingual branch, and multiple nodular shadows with random distribution. Cervical CT showed diffuse enlargement of the thyroid gland with low density. The cytology of the tumor in the left lingular branch revealed adenocarcinoma, and ultrasound-guided fine needle aspiration cytology of the thyroid gland revealed adenocarcinoma, cytologically identical to the cells from bronchoscopic examination. Immunochemically, specimens obtained from both bronchoscopy and the thyroid gland were negative for thyroglobulin. Therefore, we diagnosed this case as primary lung cancer complicated with hypothyroidism by diffuse metastasis of the thyroid gland. Metastatic thyroid tumor is rarely diagnosed clinically. Furthermore, metastatic thyroid tumor complicated with thyroid dysfunction is extremely rare. We conclude that in patients with both diffuse thyroid swelling and thyroid dysfunction, the possibility of metastatic thyroid tumor should be considered.     

慢性乙型重型肝炎合并播散性肺曲霉病1例

1.病例资料:患者男性,31岁,有HBV感染史7年,因乏力、纳差、皮肤巩膜黄染15 d入院.2008年4月2日,无诱因下出现乏力、皮肤巩膜黄染在广东东华医院住院,诊为慢性乙型肝炎重型.经保肝治疗症状无改善,逐渐出现发热腹痛,凝血酶原时间(PT)32 s,戊型肝炎抗体阴性,予头孢他定无缓解,于4月6日转往中山大学医学院附属第三医院,诊为慢性乙型肝炎重型,胆道感染,自发性腹膜炎,复查戊型肝炎抗体阴性,胸片未见异常.给予腺苷蛋氨酸、还原型谷胱甘肽、甘草酸二铵、血浆、美罗培南、替硝唑等治疗,体温正常,腹痛减轻但黄疸仍加深,PT延长,于4月12日转广西中医学院瑞康医院肝胆内科住院治疗.     

免疫性血小板减少症并发奴卡菌血症及肺曲霉菌病后继发肺腺癌一例

奴卡菌属放线菌类,携带菌的灰尘、土壤或事物通过呼吸道或消化道进入人体,或经血行播散至靶器官,能够引起局限性或播散性化脓性疾病[1]。免疫缺陷患者更易感染诺卡菌,病死率高[2]。我们报告1例播散性奴卡菌病、肺曲霉菌病混合感染的免疫性血小板减少症(immunologic thrombocytopenia,ITP)的患者,是肺恶性肿瘤继发于少见感染的病例。     

A patient with meningeal carcinomatosis and small cell lung cancer

Cranial metastasis because of lung cancer shows the poor prognosis. Cranial metastasis is common: In order lung, breast, skin, kidney, gastrointestinal system cancer is the 80% of the cause of metastasis. Cranial metastases are common in lung cancer especially in small cell lung cancer. Cranial metastasis can be seen in different location but leptomeningeal infiltration is rare and interesting. Because of this we will describe a case which has been death seven months after diagnose because leptomeningeal infiltration of small cell lung cancer.