Bulut Gülcan, Erden Asuman, Karaca Burçak, Göker Erdem
Ege University Faculty of Medicine, Department of Internal Medicine, İzmir, Bornova, Turkey.
Turk J Gastroenterol. 2011;22(2):195-8. doi: 10.4318/tjg.2011.0191.
Gastric cancer is the third most common malignancy among gastrointestinal malignancies. With the advance of new treatments, overall survival in gastric cancer is extending, and metastasis to atypical sites is seen more commonly. Leptomeningeal metastasis is one such atypical metastasis for gastric cancer. We report a case of gastric adenocarcinoma with leptomeningeal metastasis as an atypical involvement. A 39-year-old female, presenting with headache, vertigo, horizontal gaze palsy, visual disturbances, and seizures, was admitted to our hospital in August 2009. The funduscopic examination revealed the presence of bilateral papilledema. Magnetic resonance imaging of the brain showed diffuse leptomeningeal enhancement and biventricular dilatation. Cytological examination of the cerebrospinal fluid revealed malignant cells. These findings were consistent with leptomeningeal carcinomatosis. Six months before, she was diagnosed as having gastric cancer by upper gastrointestinal tract endoscopy, which was performed as a part of the diagnostic work-up to clarify the cause of her abdominal ascites. She received six cycles of docetaxel-cisplatin-5-fluorouracil for metastatic gastric cancer, and she developed the above-mentioned symptoms under chemotherapy. She was included in a craniospinal radiotherapy program and received intrathecal methotrexate treatment. We present this case report since leptomeningeal carcinomatosis of gastric cancers is a rare clinical entity, and treatment strategies remain challenging for clinicians.
胃癌是胃肠道恶性肿瘤中第三常见的恶性肿瘤。随着新治疗方法的进展，胃癌患者的总生存期在延长，非典型部位转移更为常见。软脑膜转移就是胃癌的一种非典型转移。我们报告一例胃腺癌伴软脑膜转移作为非典型受累的病例。一名39岁女性，因头痛、眩晕、水平凝视麻痹、视觉障碍和癫痫发作于2009年8月入院。眼底检查发现双侧视乳头水肿。脑部磁共振成像显示弥漫性软脑膜强化和双侧脑室扩张。脑脊液细胞学检查发现恶性细胞。这些发现符合软脑膜癌病。六个月前，她因上消化道内镜检查被诊断为胃癌，该检查作为诊断性检查的一部分，用于明确其腹水原因。她接受了六个周期的多西他赛-顺铂-5-氟尿嘧啶治疗转移性胃癌，化疗期间出现了上述症状。她被纳入全脑全脊髓放疗方案并接受鞘内甲氨蝶呤治疗。我们呈现此病例报告，因为胃癌的软脑膜癌病是一种罕见的临床实体，治疗策略对临床医生来说仍然具有挑战性。
