Leptomeningeal Carcinomatosis as the Initial Manifestation of Metastatic Disease diagnosed in Postmortem Examination: A Case Series

Leptomeningeal carcinomatosis (LMC) refers to the infiltration of malignant cells in the pia-arachnoids. LMC is undiagnosed until autopsy in about 20% of cases. A nonspecific neurologic symptomatology makes diagnosis challenging; especially in the scenario of unknown malignancy. Diagnosis is made by...

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Published inPuerto Rico health sciences journal Vol. 38; no. 1; p. 64
Main Authors Balbuena-Merle, Raisa I, Santé-Pérez, María, Pérez-Berenguer, Juan, Velez-Rosario, Román, Correa-Rivas, María, Jiménez, Alexandra
Format Journal Article
LanguageEnglish
Published Puerto Rico Universidad de Puerto Rico, Recinto de Ciencias Medicas 01.03.2019
Subjects
Autopsy
Breast Neoplasms - pathology
Child, Preschool
Female
Humans
Hydrocephalus - pathology
Male
Meningeal Carcinomatosis - diagnosis
Meningeal Carcinomatosis - pathology
Middle Aged
Rhabdomyosarcoma - pathology
Puerto Rico
Postmortem examination
Metastasis
Leptomeningeal carcinomatosis
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Summary:Leptomeningeal carcinomatosis (LMC) refers to the infiltration of malignant cells in the pia-arachnoids. LMC is undiagnosed until autopsy in about 20% of cases. A nonspecific neurologic symptomatology makes diagnosis challenging; especially in the scenario of unknown malignancy. Diagnosis is made by the identification of malignant cells in CSF; though studies have shown that serial examination may be required for acceptable accuracy. We report 3 cases with distinct neurological presentations, negative cerebrospinal fluid (CSF) examinations and neurological imaging. A 52 year old woman with history of breast cancer on remission, a 2 year old male with left ear rhabdomyosarcoma status post resection, and a 59 year old woman with communicating hydrocephalus of unknown etiology. LMC was diagnosed at autopsy and confirmed by immunohistochemistry. LMC is a complication requiring a high level of clinical suspicion. Postmortem examination is an invaluable tool to confirm LMC as part of the multidisciplinary approach aiming towards the improvement of clinical diagnosis.
ISSN:0738-0658
2373-6011