Sullivan L M, Smee R
Department Radiation Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
Australas Radiol. 2006 Jun;50(3):262-6. doi: 10.1111/j.1440-1673.2006.01577.x.
Perineural invasion resulting in leptomeningeal carcinomatosis is a rare, but well-recognized phenomenon in head and neck carcinomas. We report the rare case of a patient with a squamous cell carcinoma of the lip resulting in leptomeningeal carcinomatosis and review the relevant published work. A 51-year-old man presented with progressive facial paraesthesia after treatment for a recurrent squamous cell carcinoma of the lower lip. Cavernous sinus involvement was confirmed on MRI and he received stereotactic radiotherapy. He subsequently developed progressive lower limb neurological signs. An MRI showed multiple enhancing leptomeningeal nodules in the cervical and lumbar spine consistent with leptomeningeal carcinomatosis. Whole spine radiotherapy and dexamethasone resulted in short-term stabilization of symptoms only and he rapidly succumbed to progressive neurological disease. To our knowledge, this is the first published report of a squamous cell carcinoma of the lip resulting in leptomeningeal disease of the cauda equina. It illustrates the potential aggressive natural history of squamous cell carcinomas with perineural invasion.
神经周围侵犯导致软脑膜癌病是头颈部癌中一种罕见但已被充分认识的现象。我们报告了一例罕见的唇部鳞状细胞癌导致软脑膜癌病的病例，并回顾了相关的已发表文献。一名51岁男性在接受下唇复发性鳞状细胞癌治疗后出现进行性面部感觉异常。MRI证实海绵窦受累，他接受了立体定向放射治疗。随后他出现了进行性下肢神经体征。MRI显示颈椎和腰椎有多个强化的软脑膜结节，符合软脑膜癌病。全脊柱放疗和地塞米松仅使症状短期稳定，他很快死于进行性神经疾病。据我们所知，这是第一例关于唇部鳞状细胞癌导致马尾神经软脑膜疾病的发表报告。它说明了伴有神经周围侵犯的鳞状细胞癌潜在的侵袭性自然病程。
