Leptomeningeal carcinomatosis as primary manifestation of pancreatic cancer |
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| Affiliation: | 1. Department of Neurosurgery, University of New Mexico Hospital, MSC 10-5615, 1 University of New Mexico, Albuquerque, NM 87131, USA;2. Department of Neuropathology, Marshfield Clinic, Marshfield, WI, USA;1. Department of Neurology, The Jintan Hospital Affiliated to Jiangsu University, Changzhou 213200, China;2. Department of Cerebral Surgery, Affiliated Hospital of Nanjing Medical University, Changzhou Second People’s Hospital, Changzhou 213003, China;3. Nanjing Medical University, Nanjing 210029, China;4. Department of Orthopaedic Trauma, Affiliated Hospital of Nanjing Medical University, Changzhou Second People’s Hospital, Changzhou 213003, China;5. Central Laboratory, Changzhou Second People’s Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou 213003, China;1. University of Illinois, Department of Neurological Surgery, Chicago, IL 60612, USA;2. Emory University School of Medicine, Department of Neurological Surgery, Atlanta, GA 30307, USA;3. University of Miami Miller School of Medicine, Department of Neurological Surgery, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL 33136, USA;1. Department of Neurological Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #507, Little Rock, AR 72205, USA;2. New York University School of Medicine, New York, NY, USA;3. Department of Pediatric Neuro-oncology, New York University School of Medicine, New York, NY, USA;4. Department of Neuroradiology, New York University School of Medicine, New York, NY, USA;5. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;6. Department of Neuropathology, New York University School of Medicine, New York, NY, USA;1. Spinal Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK;2. Spinal Unit, Clinico San Carlos Hospital, Madrid 28040, Spain |
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| Abstract: | Leptomeningeal carcinomatosis (LMC) is a rare complication of cancer that often presents at an advanced stage after obvious metastasis of a primary cancer or locally advanced disease. We present an uncommon case of LMC secondary to pancreatic carcinoma presenting with headache, unilateral VII nerve palsy, and lower extremity weakness. Initial cerebrospinal fluid (CSF) studies were concerning for chronic aseptic meningitis but negative for malignant cells; the diagnosis of tuberculous meningitis was erroneously evoked. Three lumbar punctures were required to capture malignant cells. The diagnosis of LMC was based on CSF examination with cytology/immunohistochemistry and leptomeningeal enhancement on MRI. Post mortem autopsy revealed advanced and diffusely metastatic pancreatic adenocarcinoma. This patient demonstrates that solid tumors can present with leptomeningeal spread that often confuses the treating physician. Fungal or tuberculous meningitis can mimic LMC in the absence of neoplastic signs and negative CSF cytology. This event is exceedingly rare in pancreatic cancer. If the index of suspicion is high, repeat CSF sampling can increase the sensitivity of detection of malignant cells and thus result in the correct diagnosis. |
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| Keywords: | Leptomeningeal carcinomatosis Leptomeningeal disease Pancreatic carcinoma |
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