Saad Nibal, Alsibai Ahmad, Hadid Tarik H
Nibal Saad, Ahmad Alsibai, Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, MI 48236, United States.
World J Gastrointest Oncol. 2014 Dec 15;6(12):450-3. doi: 10.4251/wjgo.v6.i12.450.
While solid tumors are less commonly associated with meningeal involvement; lung, breast and melanoma are the ones most often reported. A few case reports have included gastric carcinoma but these are rare and most often associated with systemic disease at the time of diagnosis. Here we report a unique presentation of gastric carcinoma relapse with leptomeningeal carcinomatosis. An 81-year-old female was diagnosed with gastric cancer approximately one year before presentation. Following neoadjuvant chemotherapy, she had gastrectomy. Her periodic surveillance was stable. Thereafter she presented with a one week history of progressive fatigue lightheadedness, syncope. During hospitalization her mental status deteriorated. A repeat computed axial tomography scan of the head showed no changes to suggest an etiology. A lumbar puncture was performed and cerebral spinal fluid (CSF) cytopathology confirmed gastric signet cell adenocarcinoma. Encephalopathy was likely caused by increased intracranial pressure from communicating hydrocephalus. Leptomeningeal carcinomatosis is associated with short life expectancy. Therapeutic lumbar punctures and best supportive care or systemic therapy can be applied with guarded prognosis. Survival, however, may improve with cytologic negative conversion of the CSF if patient performance status allows treatment.
实体瘤较少发生脑膜受累；其中最常报道的是肺癌、乳腺癌和黑色素瘤。少数病例报告提及胃癌，但这些很罕见，且大多在诊断时伴有全身性疾病。在此，我们报告一例胃癌复发伴软脑膜癌病的独特病例。一名81岁女性在就诊前约一年被诊断为胃癌。新辅助化疗后，她接受了胃切除术。其定期监测结果稳定。此后，她出现了一周的进行性疲劳、头晕、晕厥病史。住院期间，她的精神状态恶化。头部计算机断层扫描复查未发现提示病因的变化。进行了腰椎穿刺，脑脊液细胞病理学确诊为胃印戒细胞腺癌。脑病可能是由交通性脑积水导致的颅内压升高引起的。软脑膜癌病的预期寿命较短。治疗性腰椎穿刺以及最佳支持治疗或全身治疗可用于预后不佳的情况。然而，如果患者的身体状况允许治疗，脑脊液细胞学转为阴性可能会改善生存情况。
