Ali Saeed, Khan Muhammad Talha, Idrisov Evgeny A, Maqsood Aadil, Asad-Ur-Rahman Fnu, Abusaada Khalid
Internal Medicine Residency, Florida Hospital Orlando.
Internal Medicine, Khyber Medical College.
Cureus. 2017 Mar 7;9(3):e1085. doi: 10.7759/cureus.1085.
Malignant infiltration of pia and arachnoid mater, referred to as leptomeningeal carcinomatosis (LMC), is a rare complication of gastric carcinoma. The most common underlying malignancy in patients with LMC are leukemia, breast cancer, lymphoma, and lung cancer. We report a case of gastric adenocarcinoma that presented with LMC in the absence of overt gastrointestinal signs or symptoms. A 56-year-old Hispanic woman presented to the hospital with a three-week history of intermittent headaches and visual blurring. An initial brain imaging showed infarction in the distribution of right posterior inferior cerebellar artery (PICA) along with communicating hydrocephalus. She underwent ventriculoperitoneal (VP) shunt placement with improvement in her symptoms. Two months later she presented again with deterioration in her mental status. Imaging studies and cerebrospinal fluid (CSF) analysis confirmed the diagnosis of LMC. Further studies determined the primary tumor to be signet ring cell gastric adenocarcinoma. However, she did not have any preceding gastrointestinal symptoms. In light of the poor prognosis, the patient's family proceeded with comfort care measures. Our case portrays a rare presentation of gastric adenocarcinoma with LMC without other distant organ metastatic involvement. It also illustrates the occult nature of gastric carcinoma and signifies the importance of neurologic assessment of patients, with or at risk of gastric carcinoma. It also raises a theoretical concern for VP shunt as a potential conduit of malignant cells from the abdomen to the central nervous system, which may serve as an important susbtrate for future research.
软脑膜和蛛网膜的恶性浸润，称为软脑膜癌病（LMC），是胃癌罕见的并发症。LMC患者最常见的潜在恶性肿瘤是白血病、乳腺癌、淋巴瘤和肺癌。我们报告一例胃腺癌患者，其表现为LMC，但无明显的胃肠道体征或症状。一名56岁的西班牙裔女性因间歇性头痛和视力模糊3周病史入院。最初的脑部影像学检查显示右后下小脑动脉（PICA）分布区梗死伴交通性脑积水。她接受了脑室腹腔（VP）分流术，症状有所改善。两个月后，她再次出现精神状态恶化。影像学检查和脑脊液（CSF）分析确诊为LMC。进一步检查确定原发肿瘤为印戒细胞胃腺癌。然而，她之前没有任何胃肠道症状。鉴于预后较差，患者家属采取了姑息治疗措施。我们的病例描述了一例罕见的胃腺癌合并LMC，无其他远处器官转移受累的情况。它还说明了胃癌的隐匿性，表明了对患有或有胃癌风险的患者进行神经学评估的重要性。它还引发了一个理论上的担忧，即VP分流术可能是恶性细胞从腹部进入中枢神经系统的潜在途径，这可能成为未来研究的重要基础。
