Published online Dec 15, 2014. doi: 10.4251/wjgo.v6.i12.450
Revised: November 5, 2014
Accepted: November 17, 2014
Published online: December 15, 2014
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.
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.