Published online Jan 15, 2018. doi: 10.4251/wjgo.v10.i1.56
Peer-review started: July 26, 2017
First decision: September 11, 2017
Revised: November 28, 2017
Accepted: December 4, 2017
Article in press: December 4, 2017
Published online: January 15, 2018
Two patients are presented. Both of them were presented with severe neurological symptoms and their further investigation revealed the initial diagnosis and the recurrence of gastric cancer (GC)/esophagogastric junction cancer (EGJC), respectively.
Two cases are presented. One initially diagnosed with GC and leptomeningeal carcinomatosis (LMC) but no other evidence of metastatic disease and the other one initially diagnosed with EGJC, who recurred solitary with leptomeningeal seedings several years after the initial diagnosis and treatment.
Meningeal enhancement is suggestive but does not confirm the diagnosis. Infection or inflammatory causes, intracranial hypertension but even a lumbar puncture procedure before magnetic resonance imaging (MRI) scan could induce diffuse meningeal enhancement give false positive results.
Elevation of CEA levels were reported in both patients and mild elevation of CA19-9 was reported in patient with EGJC recurrence.
Brain MRI images revealed diffuse meningeal enhancement consistent with LMC.
CSF cytology confirmed the diagnosis of LMC in both patients.
Chemotherapy, IT therapy.
Only a few cases of EGJC and GC patients have been reported with LMC as an upfront disease manifestation or as solitary disease recurrence.
EGJC/GC are diseases with high malignant potential.
Even LMC is extremely rare in patients diagnosed with EGJC and GC, physicians should be alerted when neurological symptoms occurred, are persistent and could not be explained.