Korean J Gastroenterol.  2016 Aug;68(2):93-98. 10.4166/kjg.2016.68.2.93.

A Case of Isolated Leptomeningeal Carcinomatosis from Advanced Gastric Cancer

• Ji JG
• Chung JW
• Nam SW
• Choi SK
• Lee DW
• Kim DI
• Jeon BG
• Shin YJ

• KMID: 2350086
• DOI: http://doi.org/10.4166/kjg.2016.68.2.93

Abstract

Leptomeningeal carcinomatosis (LMC) is rare metastatic form of gastric cancer. Most cases are diagnosed in the final stage after multiple distant metastasis. An 84-year-old woman was admitted with melena, headache and vomiting. Esophagogastro-duodenoscopy showed an ulceroinfiltrating lesion at the stomach (Borrmann class III), and biopsy revealed a signet ring cell carcinoma. The abdominal-pelvic CT showed no evidence of metastasis. A sudden decrease of consciousness was noted, but the brain CT showed no active lesion while the brain MRI revealed enhancement of leptomeninges. A lumbar puncture was performed and the cerebrospinal fluid study revealed malignant neoplastic cells. With family consent, no further evaluation and treatment were administered and she died six weeks after the diagnosis of gastric cancer. We report an extremely rare case of a patient who initially presented with neurologic symptoms, and was diagnosed LMC from advanced gastric cancer without any evidence of metastasis in abdomen and pelvis.

Keyword

Gastric cancer; Leptomeningeal carcinomatosis; Neurologic manifestations

MeSH Terms

Abdomen
Aged, 80 and over
Biopsy
Brain
Carcinoma, Signet Ring Cell
Cerebrospinal Fluid
Consciousness
Diagnosis
Female
Headache
Humans
Magnetic Resonance Imaging
Melena
Meningeal Carcinomatosis*
Neoplasm Metastasis
Neurologic Manifestations
Pelvis
Spinal Puncture
Stomach
Stomach Neoplasms*
Vomiting

Figure

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  Fig. 1. Endoscopic finding. Endoscopy shows a 3 cm ulceroinfiltrative lesion with irregular base, nodular elevated margin, and abnormalities of surrounding folds (Borrmann class III) at the posterior wall of the upper body.

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  Fig. 2. Pathologic findings (H&E). (A) The biopsy of stomach shows cellular infiltration with poorly differentiated adenocarcinoma, bizarre/ pleomorphic cells and few eosinophilic cells (×100). (B) Signet ring cells, characterized by a central optical clearing and globoid droplet of cytoplasmic mucin with an eccentrically placed nucleus, are observed (×400).

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  Fig. 3. MRI findings. (A) Brain MRI with gadolinium-enhanced, T1-weighted axial image shows multifocal diffuse leptomeningeal enhancement at cerebrum and cerebellum. (B) Focal enhancing nodule of 1 cm is noted on right infratentorium.

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  Fig. 4. Cytological findings (Wright's stain). (A) The cerebrospinal fluid shows a few large malignant cells with high nuclear/cytoplasmic ratio, 2–3 nucleoli, and basophilic cytoplasms (×400). (B) Adenocarcinoma includes small vacuoles and protoplasmic projection (×400).

Reference

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