Leptomeningeal carcinomatosis can be presenting manifestation of breast carcinoma

Gorana Mandic Stojmenović; Aleksandra M Pavlović; Miilica Skender Gazibara; Danica Grujičić; Aleksandra Radojičić; Nadežda Čovičković Šternić

doi:10.2298/2395

Gorana Mandic Stojmenović Neurology Clinic, Faculty of Medicine, University of Belgrade
Aleksandra M Pavlović Neurology Clinic, Faculty of Medicine, University of Belgrade
Miilica Skender Gazibara Institute of Pathology, Faculty of Medicine, University of Belgrade
Danica Grujičić Neurosurgery Clinic, Faculty of Medicine, University of Belgrade
Aleksandra Radojičić Neurology Clinic, Faculty of Medicine, University of Belgrade
Nadežda Čovičković Šternić Neurology Clinic, Faculty of Medicine, University of Belgrade

DOI: https://doi.org/10.2298/2395

Keywords: breast neoplasms, neoplasm metastasis, meningeal neoplasms, diagnosis, differential,

Abstract

Introduction. Leptomeningeal carcinomatosis (LC) is a serious complication occuring in solid cancer patients with rather poor prognosis. Case report. We presented a 47-year-old woman with the 6-month history of diffuse headache, nausea and visual obscuration. Initially, clinical status and brain magnetic resonance imaging (MRI) indicated syndrome of idiopathic intracranial hypertension. Due to clinical progression and high papillary stasis, cerebrospinal fluid (CSF) examination was performed only after ventriculoperitoneal shunt was implanted. This led to a significant although transient clinical improvement. Futher investigations led to the diagnosis of invasive lobular breast carcinoma and repeated CSF analysis revealed malignant breast carcinoma cells. In this case LC was an initial presentation of a malignant disease. Conclusion. In the presence of a high clinical suspicion of LC, in spite of initially negative findings, a clinician should persist in repeating relevant tests, such are MRI with larger amounts of gadolinium and high-volume cytological CSF analyses in order to make the diagnosis.

Author Biographies

Gorana Mandic Stojmenović, Neurology Clinic, Faculty of Medicine, University of Belgrade

none

Aleksandra M Pavlović, Neurology Clinic, Faculty of Medicine, University of Belgrade

none

Miilica Skender Gazibara, Institute of Pathology, Faculty of Medicine, University of Belgrade

none

Danica Grujičić, Neurosurgery Clinic, Faculty of Medicine, University of Belgrade

none

Aleksandra Radojičić, Neurology Clinic, Faculty of Medicine, University of Belgrade

none

Nadežda Čovičković Šternić, Neurology Clinic, Faculty of Medicine, University of Belgrade

none

References

Clarke JL, Perez HR, Jacks LM, Panageas KS, DeAngelis LM. Leptomeningeal metastases in the MRI era. Neurology 2010; 74(18): 1449−54.

Waki F, Ando M, Takashima A, Yonemori K, Nokihara H, Miyake M, et al. Prognostic factors and clinical outcomes in patients with leptomeningeal metastasis from solid tumors. J Neurooncol 2009; 93(2): 205−12.

Gauthier H, Guilhaume MN, Bidard FC, Pierga JY, Girre V, Cottu PH, et al. Survival of breast cancer patients with meningeal carcinomatosis. Ann Oncol 2010; 21(11): 2183−7.

Omuro AM, Lallana EC, Bilsky MH, DeAngelis LM. Ventriculoperitoneal shunt in patients with leptomeningeal metastasis. Neurology 2005; 64(9): 1625−7.

Chamberlain M. Leptomeningeal metastasis. Semin Neurol 2010; 30(3): 236−44.