Cases reported "Meningeal Neoplasms"

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1/41. 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.
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2/41. meningeal carcinomatosis manifested as bilateral progressive sensorineural hearing loss.

    OBJECTIVE: meningeal carcinomatosis is defined as the diffuse infiltration of the leptomeninges and subarachnoid space by malignant cells metastasizing from systemic cancer. The authors describe a rare case of meningeal carcinomatosis initially appearing as bilateral progressive sensorineural hearing loss. PATIENT: A 57-year-old man with lung cancer was referred to the authors' clinic because of progressive hearing loss, tinnitus, dizziness, and blurred vision for 1 month. RESULTS: magnetic resonance imaging revealed abnormal leptomeningeal enhancement. meningeal carcinomatosis was diagnosed by the detection of malignant cells in the cerebrospinal fluid after lumbar puncture. The patient died 1 year after diagnosis. CONCLUSIONS: meningeal carcinomatosis must be considered in the differential diagnosis in cancer patients with bilateral progressive sensorineural hearing loss. gadolinium-enhanced magnetic resonance imaging is a useful complementary diagnostic tool before lumbar puncture.
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3/41. Spinal seeding of anaplastic ependymoma mimicking fungal meningitis. A case report and review of the literature.

    BACKGROUND: The spinal seeding from brain tumors sometimes mimicks fungal meningitis on examination of cerebrospinal fluid. methods AND RESULTS: A 19-year-old woman gradually developed increased intracranial hypertension. MRI identified a mass in the right parieto-occipital area. It was totally removed and histologically diagnosed as an anaplastic ependymoma. radiation- and chemotherapy were administered postoperatively. The patient reported low back pain 5 months after the surgical treatment. MRI disclosed neither spinal dissemination nor tumor recurrence at the primary site. Lumbar puncture was performed and the cerebrospinal fluid (CSF) was found to have an extremely low glucose level (5 mg/dl); no tumor cells were identified. Blood samples were obtained and a relative increase of WBC and CRP was noted. A slight degree of inflammation and low-grade fever were recorded. A tentative diagnosis of fungal meningitis was made and anti-fungal therapy was administered transventricularly and transvenously. However, her neurological condition continued to deteriorate gradually. Sequential CSF studies showed that the glucose level remained extremely low, it even decreased to 0 mg/dl Eight months after the surgical treatment, MRI with Gd-DTPA revealed marked subarachnoid enhancement in both intracranial and spinal areas. An open biopsy was performed and a histological diagnosis of intracranial and spinal seeding of the anaplastic ependymoma was returned. CONCLUSIONS: We report a patient with intracranial and spinal seeding of an anaplastic ependymoma that mimicked fungal meningitis. We discuss the difficulty of obtaining a differential diagnosis in this case and describe the mechanism of the decreased CSF glucose level.
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4/41. Cerebrospinal fluid gastrin releasing peptide in the diagnosis of leptomeningeal metastases from small cell carcinoma.

    BACKGROUND: The clinical diagnosis of leptomeningeal metastases is often difficult to substantiate. patients with an underlying malignancy typically present with neurologic symptoms referable to multiple levels of the neuraxis. Although most patients have an abnormal cerebrospinal fluid (CSF), less than 60% have evidence of malignant cells on cytologic examination from a single lumbar puncture, and the disease is usually advanced in patients with positive results. An elevated serum level of gastrin releasing peptide (GRP) in patients with small cell carcinoma has emerged as one of the most useful markers for disease activity. methods: A patient with small cell carcinoma presented with signs of meningitis and an abnormal CSF. However, the CSF gave repeatedly negative cytologic results. Hence, serum and CSF were analyzed for GRP. RESULTS: The CSF GRP level was elevated by more than six orders of magnitude above the serum level. An autopsy demonstrated extensive meningeal and parenchymal brain involvement by small cell carcinoma. CONCLUSIONS: The diagnosis of leptomeningeal metastases in patients with small cell carcinoma can be established by CSF GRP testing, even when cytologic examination is negative.
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5/41. Intracranial subdural hematoma after puncture of spinal meningeal cysts.

    A patient is reported with an intracranial subdural hematoma after puncture of spinal meningeal cysts. In this case, spinal meningeal cysts were diagnosed by myelography. No intracranial subdural hematoma was detected immediately after myelography. Deterioration in the patient's level of consciousness occurred after puncture of the cysts. The authors speculated that the cerebrospinal fluid pressure dropped rapidly when the spinal meningeal cysts were punctured. This displaced the cerebral bridging veins downward, tearing them and resulting in an intracranial subdural hematoma.
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6/41. adult T-cell lymphoma involving the leptomeninges associated with a spinal cord schwannoma.

    adult T-cell lymphoma (ATL-L) developing initially in the meninges is rare. An autopsy case of ATL-L with an acute onset of meningitis and generalized lymphadenopathy in association with a cervical cord schwannoma is reported here. A 78-year-old woman with sensori-motor weakness of both arms over a 1-year period, developed febrile episodes and drowsiness with neck stiffness. Lumbar puncture revealed an increased protein content (161 mg/dL) and increased cell count (463/3) consisting of 99% of lymphocytes which contained atypical lymphocytes with multilobulated nuclei ('flower cells'), which are characteristic of ATL-L. Viral titers were positive only for htlv-i antibodies (serum X 640: CSF X 16). biopsy of an enlarged retroperitoneal lymph node revealed malignant lymphoma of the T-cell type. brain MRI was negative, whereas an intradural extramedullary mass was found at the C4 level. With a diagnosis of ATL-L stage IV, chemotherapy was commenced, which was effective in reducing the generalized lymphadenopathy as well as the cervical mass and restoring the CSF findings to normality. The cervical cord mass was verified to be a solitary schwannoma, and ATL-L involvement was found not only in the leptomeninges, but also within the cervical cord schwannoma.
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7/41. Meningeal relapse after double peripheral blood stem cell transplantation in IgD myeloma.

    A 54-year-old man diagnosed with IgD myeloma (stage IIIA) in complete remission (CR) received peripheral blood stem cell transplantation (PBSCT) twice with an interval of 4 months using high-dose melphalan 200mg/m2. However 9 months after the second PBSCT, he was readmitted because of lumbago, lower left hemiparesis, speech disturbance and left facial nerve palsy. A lumbar puncture revealed myeloma cells in the cerebrospinal fluid (CSF). The patient did not respond to any salvage chemotherapy and died of sepsis 27 months after the initial diagnosis. The findings in this patient suggest that another treatment modality including prophylactic intrathecal injection of an anti-cancer drug as well as allogeneic cell therapy is probably necessary in patients with high-risk IgD myeloma.
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8/41. diplopia in a patient with carcinomatous meningitis: a case report and review of the literature.

    In a patient with a history of malignancy, an isolated neurologic sign or symptom may indicate metastasis to the central nervous system. To exclude this possibility, a lumbar puncture should still be performed after a nondiagnostic cranial computed tomography (CT) scan even in the absence of signs of infection. A case is presented of a 59 year-old man recently diagnosed with non-Hodgkin's lymphoma that presented to the Emergency Department (ED) with the sole complaint of diplopia. Examination was unremarkable except for a left abducens nerve palsy. Cranial CT scan was normal but initial cerebrospinal fluid results were suggestive of carcinomatous meningitis, and cytology results later confirmed this diagnosis. A review of diplopia and carcinomatous meningitis is presented, along with a suggested conservative diagnostic algorithm for cancer patients presenting with neurologic signs or symptoms.
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9/41. Primary nodular meningeal glioma mimicking metastatic tumor of the cerebellum with diffuse infra- and supratentorial leptomeningeal spread.

    A 62-year-old man presented with acute headache, blurred and double vision, nausea, and ataxia. magnetic resonance imaging showed an enhancing mass on the inferior aspect of the right cerebellar hemisphere as well as a thin, widespread leptomeningeal enhancement and T2-weighted hyperintense lesions in the left occipital lobe and both thalami. Lumbar puncture revealed clusters of anaplastic cells. Therefore, metastatic tumor of unknown origin was suggested. Despite whole brain irradiation and intrathecal chemotherapy the patient deteriorated gradually and died four months later. Post-mortem examination of the brain revealed a nodular, high-grade astrocytic tumor within the subarachnoid space on the lower portion of the right cerebellar hemisphere. Diffuse leptomeningeal spread was noted, but cerebellar parenchyma was not infiltrated.
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10/41. Suboccipital lateral injection of intrathecal chemotherapy in a patient with mantle cell lymphoma.

    BACKGROUND: Even today patients who suffer from mantle cell lymphoma have a poor prognosis, especially when the CNS is involved. To confirm the diagnosis of meningeosis lymphomatosa, asservation of the liquor cerebrospinalis is necessary. During this procedure, intrathecal chemotherapy may be given if there is clinical evidence of meningeosis. If lumbar puncture cannot be performed, a lateral suboccipital puncture may be an alternative approach. patients AND methods: We report the case of a 65-year-old patient who suffered from mantle cell lymphoma stage IV. The patient presented with symptoms of progressive paraparesis of both legs and incontinence, with tumor mass intradural from the 12th thoracic vertebra to the level of S1. During irradiation, the patient developed symptoms of diffuse meningiosis lymphomatosa. The conventional lumbar puncture was impossible, because of tumor present in the thoracico-lumbar junction. RESULTS: A suboccipital puncture was performed for both collecting cerebrospinal fluid and application of chemotherapy (cytosine arabinoside/dexamethasone). This lead to remarkable improvement of the patient's clinical symptoms. CONCLUSIONS: The suboccipital cervical puncture was performed without complications. A variation of the intrathecal approach is described, which may serve as alternative when conventional lumbar puncture is not possible.
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