Case Report
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World J Gastrointest Oncol. Dec 15, 2014; 6(12): 450-453
Published online Dec 15, 2014. doi: 10.4251/wjgo.v6.i12.450
Carcinomatous meningitis due to gastric adenocarcinoma: A rare presentation of relapse
Nibal Saad, Ahmad Alsibai, Tarik H Hadid
Nibal Saad, Ahmad Alsibai, Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, MI 48236, United States
Tarik H Hadid, Department of internal medicine, Division of oncology, St. John Hospital and Medical Center, Detroit, MI 48236, United States
Author contributions: Saad N researched/reviewed the current literature and wrote the paper; Alsibai A provided the images and reviewed manuscript; Hadid TH reviewed manuscript and gave the final approval of the version to be published.
Correspondence to: Nibal Saad, MD, Resident Physician, Department of Internal Medicine, St. John Hospital and Medical Center, 19251 Mack Ave, Suite 335, Grosse Pointe Woods, MI 48236,United States. nibalsaad@yahoo.com
Telephone: +1-313-7066607 Fax: +1-313-3437784
Received: July 3, 2014
Revised: November 5, 2014
Accepted: November 17, 2014
Published online: December 15, 2014
Processing time: 168 Days and 3.7 Hours
Abstract

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.

Keywords: Gastric cancer; Gastric adenocarcinoma; Leptomenigeal carcinomatosis; Signet cell adenocarcinoma; Carcinomatous meningitis

Core tip: Solid tumors rarely have leptomeningeal carcinomatosis. Gastric adenocarcinoma have been rarely reported with leptomeningeal involvement, and most of the reports have been documented in patients with Asian heritage, who have higher incidence of gastric adenocarcinoma. This leptomeningeal involvement is usually a late complication of disseminated and relapsed disease. In this case, however, we describe a patient with recurrence of gastric adenocarcinoma that presented with leptomenigeal carcinomatosis. We describe the presentation, the pertinent medical history of the patient, and the clinical outcome of the disease. We highlighted that leptomeningeal carcinomatosis can be a presentation of relapse, which is rare, and indicates a poor prognosis.