Cioni Elisa, Marchiani Costanza, Gagliano Manfredi, Bandini Giulia, Palagano Nicolas, Ciuti Gabriele, Moggi Pignone Alberto
Department of Internal Medicine 4, Careggi University Hospital, University of Florence, Florence, Italy.
Am J Case Rep. 2020 Oct 3;21:e925599. doi: 10.12659/AJCR.925599.
BACKGROUND Signet ring cell (SRC) gastric adenocarcinoma is an aggressive histotype associated with poor prognosis, especially in advanced gastric cancer. Dural metastasis is rarely described in the literature, and clinical manifestations are generally related to subdural hematoma. Here we present a case of advanced SRC gastric cancer with dural neoplastic involvement in the absence of subdural hematoma or subdural fluid collection. CASE REPORT A 39-year-old woman presented with multiple episodes of confusion and headache. She had a history of SRC gastric adenocarcinoma that had been treated with neoadjuvant chemotherapy and total gastrectomy without evidence of disease relapse at follow-up. During hospitalization, she experienced persistent drowsiness and frequent generalized seizures that were nonresponsive to antiepileptic drugs. Brain computed tomography showed a dural right parafalcine nodular lesion suggestive of metastasis, and an SRC presence was detected in a cerebrospinal fluid sample. Cerebral magnetic resonance imaging showed isolated diffuse dural neoplastic involvement without evidence of subdural hematoma or subdural fluid collection. We considered palliative treatment with intrathecal chemotherapy, but it was not carried out because of clinical worsening and subsequent death. CONCLUSIONS In the very few case reports in the literature, dural metastasis in advanced gastric cancer is mainly associated with subdural hematoma. In our case, the absence of any subdural effusion, which is an even rarer condition, along with an unusual clinical presentation dominated by generalized seizures represented a diagnostic challenge. Given the aggressive course of the disease, a rapid diagnosis could allow a faster specific treatment to relieve a patient's symptoms.
背景 印戒细胞(SRC)胃腺癌是一种侵袭性组织学类型,与预后不良相关,尤其是在晚期胃癌中。硬脑膜转移在文献中很少被描述,临床表现通常与硬膜下血肿有关。在此,我们报告一例晚期SRC胃癌患者,其硬脑膜有肿瘤累及,但无硬膜下血肿或硬膜下积液。病例报告 一名39岁女性出现多次意识模糊和头痛发作。她有SRC胃腺癌病史,曾接受新辅助化疗和全胃切除术,随访时无疾病复发迹象。住院期间,她持续嗜睡,频繁出现全身性癫痫发作,对抗癫痫药物无反应。脑部计算机断层扫描显示右旁矢状窦硬脑膜有一个结节状病变,提示转移,脑脊液样本中检测到SRC。脑磁共振成像显示孤立的弥漫性硬脑膜肿瘤累及,无硬膜下血肿或硬膜下积液迹象。我们考虑采用鞘内化疗进行姑息治疗,但由于临床病情恶化及随后的死亡而未实施。结论 在文献中极少的病例报告中,晚期胃癌的硬脑膜转移主要与硬膜下血肿有关。在我们的病例中,没有任何硬膜下积液(这是一种更为罕见的情况),以及以全身性癫痫发作为主的不寻常临床表现构成了诊断挑战。鉴于该疾病的侵袭性病程,快速诊断可以使患者更快地接受针对性治疗以缓解症状。