Elsevier

Surgical Neurology

Volume 65, Issue 4, April 2006, Pages 372-375
Surgical Neurology

Neoplasm
Leptomeningeal carcinomatosis in a patient with metastatic prostate cancer: case report and literature review

https://doi.org/10.1016/j.surneu.2005.08.026Get rights and content

Abstract

Background

Leptomeningeal metastasis is discovered at autopsy in approximately 5% of patients with systemic cancer. Until recently with the introduction of magnetic resonance imaging (MRI), premorbid diagnosis was extremely difficult. In particular, initial spinal fluid cytology is diagnostic in less than 50% of autopsy-verified patients, although repeated spinal fluid examinations may increase the yield significantly. Leptomeningeal metastasis in metastatic prostate cancer has been reported in only 14 patients previously.

Case Description

We recently studied such a patient and were able to establish a correct diagnosis based solely on the MRI and the presence of an elevated cerebrospinal fluid (CSF) prostate-specific antigen (PSA). Only 3 previous patients with leptomeningeal prostate metastasis have undergone CSF PSA evaluations.

Conclusion

We believe that, in such patients, the combination of MRI and CSF studies can overcome the lack of sensitivity of CSF cytology.

Section snippets

Case report

A 76-year-old retired white male engineer was hospitalized in November 2004 for the recent onset of confusion and right-sided headaches in the frontoparietal and vertex area. These complaints had evolved over the past 5 days.

Of significance in his history was hypertension treated with diltiazem for 20 years and a diagnosis of prostate cancer treated by radical prostatectomy in October 1994. His PSA at the time of surgery was 12 ng/mL. A preoperative biopsy revealed an invasive poorly

Discussion

Leptomeningeal metastasis is found at autopsy in 5% of patients with systemic cancers [25]. However, an antemortem diagnosis is much less commonly confirmed, reflecting the difficulty in making the diagnosis clinically or with laboratory studies. Although it can be diagnosed when malignant cells are detected by cytological examination of the CSF, repeated examinations may be necessary to establish the diagnosis [21], [26], and even then, the CSF cytology is unremarkable in 5% to 10% of patients

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    1

    Present address: John F. Kennedy Memorial Hospital, Indio, CA 92201.

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