Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2015; 21(3): 1020-1023
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.1020
Rare case of pancreatic cancer with leptomeningeal carcinomatosis
In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Jong Jin Hyun
In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea
Jong Jin Hyun, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital 123, Gyeonggi-do 425-707, South Korea
Author contributions: Kim CD and Chun HJ designed the report; Jeen YT, Keum B and Kim ES collected the patient’s clinical data; Choi HS, Lee JM, Kim SH and Nam SJ performed the research; Yoo IK wrote the paper; and Lee HS approved the final version of the paper to be published; all authors finally revised this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong Sik Lee, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, South Korea. hslee60@korea.ac.kr
Telephone: +82-10-86502455 Fax: +82-2-9531943
Received: May 28, 2014
Peer-review started: May 29, 2014
First decision: June 27, 2014
Revised: July 6, 2014
Accepted: September 5, 2014
Article in press: September 5, 2014
Published online: January 21, 2015
Abstract

Leptomeningeal carcinomatosis occurs very rarely in patients with pancreatic cancer. Leptomeningeal carcinomatosis is characterized by multifocal seeding of the leptomeninges by malignant cells that originate from a solid tumor. To the best of our knowledge, brain metastasis from pancreatic cancer is extremely rare. Leptomeningeal carcinomatosis is estimated to occur in 3% to 8% of cases of solid tumors. The clinical manifestation usually involves neurological symptoms, including dizziness, headache, vomiting, nausea, and hemiparesis, symptoms similar to those of meningitis or brain tumors. Diagnostic methods for leptomeningeal carcinomatosis include brain magnetic resonance imaging and cerebrospinal fluid examination. Here, we describe a case of leptomeningeal carcinomatosis in which the primary tumor was later determined to be pancreatic cancer. Brain magnetic resonance imaging findings showed mild enhancement of the leptomeninges, and cerebrospinal fluid cytology was negative at first. However, after repeated spinal taps, atypical cells were observed on cerebrospinal fluid analysis and levels of tumor markers such as carbohydrate antigen 19-9 in cerebrospinal fluid were elevated. Abdominal computed tomography, performed to determine the presence of extracerebral tumors, revealed pancreatic cancer. Pancreatic cancer was confirmed histopathologically on examination of an endoscopic ultrasound-guided fine needle aspiration specimen.

Keywords: Pancreatic cancer, Radiation therapy, Tumor marker, Leptomeningeal carcinomatosis, Prognosis

Core tip: Leptomeningeal carcinomatosis with pancreatic cancer is a relatively rare finding. To date, only a few cases of brain metastasis originating from pancreatic cancer have been reported. Here, we report on a patient presenting with neurologic symptoms who was found to have pancreatic cancer with leptomeningeal metastasis, and we review the relevant literature.