[A case of leptomeningeal carcinomatosis: demonstration of CA19-9 and CEA positive malignant cells in the CSF and particular elevation of CA19-9 level in the CSF].

A 44-year-old male was admitted for diplopia, headache and gait disturbance. Neurological examination revealed the meningeal irritation sign, the Vth, VII, VIth, IXth and the Xth nerve palsies and cerebellar ataxia of all four limbs. Laboratory studies carried out on the day of admission demonstrated the elevation of serum levels of both tumor markers, carbohydrate 19-9 (CA19-9) and carcinoembryonic antigen (CEA). The estimated serum concentrations of CA19-9 and CEA were 39.4 U/ml and 81.1 ng/ml, respectively. The cerebrospinal fluid (CSF) contained 9 cells/mm3 which consisted of the mixture of malignant cells with appearance strongly suggestive of poorly differentiated adenocarcinoma and of hemosiderinphagocytizing macrophages. Detection of both CA19-9 and CEA in the tumor cells in the CSF was undertaken by the avidin biotinylated peroxidase complex method by use of monoclonal antibodies against each marker. As the results the following findings were obtained. Namely, although all the tumor cells isolated from the CSF were found to contain both tumor markers, CA19-9 and CEA, there was found a difference in the concentration ratio in CSF vs serum between the markers. The estimated concentration of CA19-9 (61.4 U/ml) in CSF was approximately 1.6 times higher than that in serum. On the other hand, the CSF concentration of CEA remained constantly very low (1.1 ng/ml) as compared with that in the serum throughout the whole course of the disease. In response to intrathecal administration of cytarabine and brain irradiation, the CSF cytological findings became normal and concomitant decrease in the concentration of CA19-9 was demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)