1/259. A case of leptomeningeal metastasis from lung adenocarcinoma diagnosed by reverse transcriptase-polymerase chain reaction for carcinoembryonic antigen.A case of leptomeningeal metastasis from lung adenocarcinoma is reported. In this case, we evaluated the feasibility of reverse transcriptased polymerase chain reaction (RT-PCR) methods to detect cancer cells in cerebrospinal fluids (CSF). Messenger rna of carcinoembryonic antigen (CEA) was clearly demonstrated in CSF by reverse RT-PCR methods. An immunohistochemical study also demonstrated that tumor cells were stained positive with anti-CEA antibody. This case suggests that RT-PCR for CEA was a sensitive and useful method to diagnose leptomeningeal metastasis from lung adenocarcinoma.- - - - - - - - - - ranking = 1keywords = cerebrospinal (Clic here for more details about this article) |
2/259. Primary melanocytoma arising from the thoracic leptomeninges case.Primary melanocytoma arising from the leptomeninges of the spinal cord is very rare. A surgical specimen of a thoracic meningeal tumor was resected from a 75-year-old woman complaining of gait disturbance was investigated. magnetic resonance imaging and myelography showed a dumb-bell-type tumor in the subdural space at the 1st to 2nd thoracic vertebrae. The tumor was subtotally resected because of adhesion to the lamina and thoracic medulla. The localized, gelatinous black tumor showed a well-defined margin without dissemination or infiltration. The tumor had a thin capsule and was composed of solid proliferation of neoplastic melanocytes. Neither whorl formation nor foci of palisaded nuclei were observed. The neoplastic cells were of two major types: an epithelioid- or polygonal-shaped type and a spindle-shaped type, and had a large nucleus, a prominent nucleolus, coarse chromatin, and melanin-pigments in their cytoplasm. Only a few mitotic figures were observed. They were positive for HMB-45 and S-100 protein. This case was considered to be primary melanocytoma arising from the thoracic leptomeninges.- - - - - - - - - - ranking = 3.0882897954568keywords = subdural (Clic here for more details about this article) |
3/259. A leptomeningeal metastasis revealed by sciatica.Meningeal metastatic disease usually occurs as a complication of a brain tumor and is exceptionally isolated in patients with solid tumors. We report the case of a 74-year-old woman admitted for mechanical S1 sciatica refractory to drug therapy. She had been treated for breast cancer three years earlier. Physical findings were pain upon hyperextension of the lumbar spine and absence of the ankle jerks. Analysis of cerebrospinal fluid sampled during an intrathecal glucocorticoid injection showed 1 g/L of protein and 11 normal cells per mm3. Grade 3 L5-S1 spondylolisthesis was seen on plain radiographs, computed tomography scans, and magnetic resonance imaging scans. At that point, the patient developed sphincter dysfunction and motor loss in the left lower limb in the distribution of several nerve roots. Findings were normal from a myelogram and a magnetic resonance imaging study of the brain. A repeat cerebrospinal fluid analysis showed 1.1 g/L of protein and 5 cells/mm3. Because of the discrepancy between the clinical and imaging study findings, the patient was transferred to a neurology department. A third cerebrospinal fluid study showed numerous adenocarcinoma cells, and a repeat magnetic resonance imaging demonstrated a mass in the dural sac opposite L2. A program of monthly intrathecal methotrexate injections was started. A fatal meningeal relapse occurred eight months later. CONCLUSION: This case shows that a leptomeningeal metastasis can cause isolated nerve root pain, and demonstrates the diagnostic value of magnetic resonance imaging and cerebrospinal fluid cytology in patients with atypical symptoms, particularly when there is a history of malignant disease.- - - - - - - - - - ranking = 4keywords = cerebrospinal (Clic here for more details about this article) |
4/259. Acute subdural hematoma and pachymeningitis carcinomatosa: case report.Subdural hematomas may affect 0.4-5 p. 100 of patients with cancer, because of predisposing risk factors or because of the cancer itself. The most likely association is with hematological cancer with coagulative disorders. An association with pachymeningitis carcinomatosa is less likely. In this instance the subdural hematoma is due to a neoplastic obstruction of dural vein with subdural engorgement and hemorrhage or subdural effusion. We report a case in which an acute neurological deterioration due to a subdural hematoma disclosed a dural metastasis from a breast cancer operated four years earlier and present a literature review.- - - - - - - - - - ranking = 24.710258264462keywords = subdural, effusion (Clic here for more details about this article) |
5/259. Falx meningioma presenting as acute subdural hematoma: case report.BACKGROUND: Acute subdural hematomas caused by meningiomas have been rarely encountered. Pathophysiologic mechanisms and clinical considerations in these patients have not been sufficiently explored. We addressed the possible mechanism of spontaneous hemorrhage in our case and briefly discuss the optimal treatment. CASE DESCRIPTION: This case of falx meningioma presenting as an acute subdural hematoma in a 78-year-old woman is described. On initial computed tomography (CT), an enhancing tumor of the falx appeared to be the cause of hemorrhage. Only faint contrast staining in the periphery of the tumor was seen on right external carotid arteriograms, with no evidence of other vascular supply. Extravasation of contrast material during the procedure occurred suddenly and was successfully treated by endovascular embolization using a microcatheter. The hematoma was emergently evacuated with gross total removal of the tumor. Pathologic examination confirmed a transitional meningioma with abundant hyalinized structures. Disruption of a thin-walled vessel adjacent to the tumor capsule was assumed to be the site of hemorrhage. CONCLUSIONS: The longstanding ischemia of the tumor was considered to have produced the deposition of hyalin in the tissue, which changed the hemodynamics within the tumor, producing vascular stress leading to rupture. The prognosis of patients with meningiomas complicated by acute subdural hematoma is generally poor, with mortality reported in approximately one-half of such patients. Surgical exploration is the most effective treatment and should be conducted before irreversible brain damage has occurred.- - - - - - - - - - ranking = 21.618028568197keywords = subdural (Clic here for more details about this article) |
6/259. Leptomeningeal carcinomatosis and cranial nerve palsy as presenting symptoms of a clinically inapparent gallbladder carcinoma.We present an occult metastatic signet-ring cell gallbladder carcinoma in a 78-year-old woman, who complained of recurrent headaches, dysarthria, and paresis of the tongue. Cranial imaging showed contrast enhancement of the basal leptomeninges, and the cerebrospinal fluid displayed clusters of adenocarcinoma cells proposed as leptomeningeal carcinomatosis of the breast, lung or gut. However, postmortem examination revealed the gallbladder as the site of the primary carcinoma with focal signet-ring cell differentiation. In patients with progressive neurologic deterioration due to leptomeningeal carcinomatosis, adenocarcinomas from the gastrointestinal and hepatic systems should be considered. It is likely that signet-ring cell carcinomas display an increased affinity to leptomeningeal spread.- - - - - - - - - - ranking = 1keywords = cerebrospinal (Clic here for more details about this article) |
7/259. Kaposi's sarcoma-associated herpesvirus-positive primary effusion lymphoma arising in the subarachnoid space.Primary effusion lymphoma (PEL) is a rare and distinctive type of B-cell non-Hodgkin's lymphoma (NHL) that occurs primarily, although not exclusively, in patients with AIDS. It usually develops as a lymphomatous effusion in the absence of a tumor mass, characteristically contains the Kaposi's sarcoma-associated herpesvirus/human herpesvirus 8 (KSHV/HHV-8), usually also contains the Epstein-Barr virus (EBV), displays a characteristic cytomorphology bridging immunoblastic and anaplastic large cell lymphoma, often expresses an indeterminate immunophenotype, and a B-cell genotype. Thus far, PEL has been limited almost entirely to the pleural, peritoneal, and pericardial cavities. We describe a NHL occurring in a gay man with AIDS that is typical of PEL in that it arose in a body cavity or space without an associated tumor mass, displays the cytomorphology typical of PEL, is a clonal B-cell neoplasm, and contains KSHV as well as EBV. This case is singularly distinctive in that it is the first case of PEL reported to arise in the subarachnoid space. This unique case further supports the strong association between KSHV and malignant lymphoma arising in body cavities and growing as an effusion.- - - - - - - - - - ranking = 0.027579305654768keywords = effusion (Clic here for more details about this article) |
8/259. meningioma recurrence at a different site masquerading as a subdural hematoma. Case report.It is unusual for a meningioma to recur at a distant site. It is more unusual for a meningioma to present as a subdural hematoma. The authors report a unique case in which both of these events occurred in the same patient during a 4-year period. The authors discuss the pathogenesis of these rare events with regard to meningiomas.- - - - - - - - - - ranking = 15.441448977284keywords = subdural (Clic here for more details about this article) |
9/259. MRI appearances mimicking the dural tail sign: a report of two cases.We report two cases in which the MRI appearances mimicked the dural tail sign; a glioma extending into the subarachnoid space, and a meningioma extending to the subdural space. They indicate that tumour invasion into the subarachnoid or subdural space, should be considered when prominent linear enhancement is observed along the dura mater adjacent to tumours.- - - - - - - - - - ranking = 6.1765795909135keywords = subdural (Clic here for more details about this article) |
10/259. Diagnostic value of immunocytochemistry in leptomeningeal tumor dissemination.Differentiating chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis can be difficult, particularly when the differentiation is based solely on routine cytologic examination. The diagnosis of cerebrospinal fluid tumor dissemination in at-risk patients requires cytologic examination of cerebrospinal fluid and radiography of the leptomeninges. Routine cytologic examination alone has proven less than desirable, in most instances providing confirmation in as little as 50% of cases in the first lumbar puncture. This percentage increases to 85% to 90% after multiple lumbar punctures. We retrospectively reviewed 2 cases of leptomeningeal dissemination (one gliomatosis, the other carcinomatosis) with initial false-negative test results. However, after further examination of the cerebrospinal fluid by selected battery of immunocytochemical stains, both cases were identified as positive for malignancy (ie, false negatives). Immunocytochemistry can be useful in distinguishing chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis in patients at risk or when abnormal cells are seen on routine cerebrospinal fluid cytologic examination.- - - - - - - - - - ranking = 4keywords = cerebrospinal (Clic here for more details about this article) |
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