Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru.
Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
F1000Res. 2022 Aug 2;11:885. doi: 10.12688/f1000research.122434.2. eCollection 2022.
Leptomeningeal metastasis is an infrequent form of cancer expression, and it has a poor prognosis due to its torpid evolution and its challenging diagnosis. We report the case of a 68-year-old woman with rapidly progressing cognitive decline and focal epilepsy. Brain magnetic resonance imaging showed extensive gyriform hypersignal in the right precentral sulcus region, without mass effect, tenuous contrast uptake, and hydrocephalus with transependymal edema. The body tomographic study was negative for solid cancer and the 18F-FDG PET-CT revealed a severe hypermetabolism in the right lung upper lobe. These findings were suggestive of lung cancer with leptomeningeal metastasis. We performed a brain biopsy, finding atypical cells in the leptomeningeal region with positive immunohistochemical staining for CK7 and negative for CK20 corresponding to lung adenocarcinoma. The patient was evaluated in the oncology service and scheduled for radiotherapy and chemotherapy. Focal leptomeningeal disease is an entity that should be considered as a differential diagnosis in all cases of focal leptomeningitis. Timely diagnosis and adequate cancer management can increase patient survival.
脑膜转移是一种罕见的癌症表现形式，由于其缓慢的进展和具有挑战性的诊断，预后较差。我们报告了一例 68 岁女性，表现为认知功能迅速下降和局灶性癫痫。脑部磁共振成像显示右中央前回区域广泛出现脑回状高信号，无肿块效应、微弱的对比摄取和伴有室管膜下水肿的脑积水。全身断层扫描未发现实体瘤，18F-FDG PET-CT 显示右上肺叶严重高代谢。这些发现提示肺癌伴脑膜转移。我们进行了脑部活检，发现脑膜区域有非典型细胞，免疫组化染色 CK7 阳性，CK20 阴性，符合肺腺癌。患者在肿瘤科接受评估，并计划进行放疗和化疗。局灶性脑膜疾病是所有局灶性脑膜炎症病例中都应考虑的鉴别诊断。及时诊断和适当的癌症治疗可以提高患者的生存率。
