Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2018; 10(1): 56-61
Published online Jan 15, 2018. doi: 10.4251/wjgo.v10.i1.56
Leptomeningeal metastases originated from esophagogastric junction/gastric cancer: A brief report of two cases
Panteleimon Kountourakis, Demetris Papamichael, Haris Haralambous, Michael Michael, Georgios Nakos, Sylvia Lazaridou, Eleni Fotiou, Vassilios Vassiliou, Demetrios Andreopoulos
Panteleimon Kountourakis, Demetris Papamichael, Sylvia Lazaridou, Eleni Fotiou, Department of Medical Oncology, BOC Oncology Centre, Nicosia 2006, Cyprus
Haris Haralambous, Demetrios Andreopoulos, Department of Radiology, BOC Oncology Centre, Nicosia 2006, Cyprus
Michael Michael, Department of Cytology, General Hospital of Nicosia, Nicosia 2029, Cyprus
Georgios Nakos, Department of Pathology, General Hospital of Nicosia, Nicosia 2029, Cyprus
Vassilios Vassiliou, Demetrios Andreopoulos, Department of Radiation Oncology, BOC Oncology Centre, Nicosia 2029, Cyprus
Author contributions: Kountourakis P designed the case reports presentation; Kountourakis P, Papamichael D and Andreopoulos D participated in manuscript preparation, revision, patient’s investigation and treatment; Haralambous H provided the CT- MRI images; Michael M provided the cytology images; Nakos G provided the pathology images; Lazaridou S, Fotiou E and Vassiliou V participated in patients’ investigation and treatment.
Informed consent statement: Patients are deceased and verbal consents were obtained at the time of their hospitalization.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: Panteleimon Kountourakis, MD, PhD, Medical Oncology Department, BOC Oncology Centre, 32 Acropoleos Ave, Nicosia 2006, Cyprus. pantelis.kountourakis@bococ.org.cy
Telephone: +357-22-847402
Received: July 24, 2017
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
ARTICLE HIGHLIGHTS
Case characteristics

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.

Clinical diagnosis

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.

Differential diagnosis

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.

Laboratory diagnosis

Elevation of CEA levels were reported in both patients and mild elevation of CA19-9 was reported in patient with EGJC recurrence.

Imaging diagnosis

Brain MRI images revealed diffuse meningeal enhancement consistent with LMC.

Pathological diagnosis

CSF cytology confirmed the diagnosis of LMC in both patients.

Treatment

Chemotherapy, IT therapy.

Related reports

Only a few cases of EGJC and GC patients have been reported with LMC as an upfront disease manifestation or as solitary disease recurrence.

Term explanation

EGJC/GC are diseases with high malignant potential.

Experiences and lessons

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.