Meningeal carcinomatosis: three case-reports

Female, 40 years old, visited our hospital because of discontinuous hypogastralgia for 4 months. After auxiliary examination, the patient was diagnosed with malignant tumor of pelvic cavity and phase II cervical cancer. After four treatment courses of neoadjuvant chemotherapy, the patient received extended total hysterectomy, bilateral adnexectomy, and partial greater omentum resection under venous inhalation anesthesia on December 8, 2016. Postoperative pathological report showed no cancer cells in the peritoneal fluid. In the left adnexal region, the ovary and muscular layer of the fallopian tube were tested. Results showed poorly differentiated adenocarcinoma in the serosa and partial signet-ring cell carcinoma, suggesting the exclusion of metastasis clinically. In the total uterus, more tumor thrombi were observed in the endometrial and muscular layers, cervix uteri, and vessels of vaginal cuff, while the parametrium was not involved. In the greater omentum, poorly differentiated adenocarcinoma invasion was observed in the adipose tissue of the omentum. In the right adnexal region, the ovary and muscular layer of the fallopian tube were tested, which showed poorly differentiated adenocarcinoma in the serosa and partial signet-ring cell carcinoma. A9 immunohistochemistry revealed CK7(+) CK20(+) Villin (+) CDX-2(+) P16(+) CA125(−) ER (−) PR (−) EGFR (weak+) P53(−) Ki67(70%+) Cadherin-17(+). After surgery, the patient received two courses of treatment, and the chemoradiotherapy regimen was as follows: paclitaxel of 240 mg, carboplatin of 300 mg, and simultaneous treatment was given to stop vomiting and for liver protection. No side effects were observed by significant chemotherapy (such as nausea and vomiting). Two weeks after chemotherapy, the patient had symptoms such as headache, nausea, and vomiting, and the symptoms were significantly aggravated at 3 days after hospitalization in the Neurosurgery Department. The patient was then transferred to our department as metastatic cancer has been diagnosed by the Outpatient Department. Diet and sleep conditions remained poor during the disease course but had no abnormal fecal and urinary functions. No significant changes in the body weight were observed. Results of cerebrospinal abbreviation examination performed on February 27, 2017, and March 01, 2017, were shown in Table 1.

Cerebrospinal abbreviation findings indicated that the size of the tumor cells was abnormal, the hyperchromatic karyosome distribution was nonuniform, cells were crowded without polarity, and the karyotheca was thickened and rough and dispersed in the lymphocytes (Fig. 1).

MRI indicated abnormal strip-shaped high-density shadow on the top and occipitalia regions (Fig. 2).

Magnetic resonance venography (MRV) imaging examination showed unclear left transverse sinus, clear imaging of sinus sagittalis superior, sinus sagittalis inferior, great cerebral veins, sinus confluens, sinuses rectus sinus sigmoideus, and right transverse sinus with normally arranged vessels. There were no significant filling defects (Fig. 3). Radiotherapy and chemotherapy were recommended, while the patient chose whole-brain radiotherapy and died 4 weeks later.

Male, 64 years old, showed symptoms like dizziness and headache with nausea 1 month before hospitalization. Headache was manifested as a whole-brain discontinuous distending pain. The pain was not significantly relieved even after oral administration of painkillers. Headache was gradually aggravated for the past week before hospitalization, and so, the patient visited our hospital. Head MRI diagnosed intracranial space-occupying lesion, and hence, the patient was hospitalized. During the disease course, the patient had no disturbances of consciousness and fever but had frequent vomiting and cramps, as well as poor sleep and diet conditions. The patient underwent lower right lung cancer radical operation 3 months ago, and the pathological report indicated squamous cell lung carcinoma.

The results of cerebrospinal abbreviation on July 05, 2016, were shown in Table 2.

Cerebrospinal abbreviation findings of tumor cells indicated (Fig. 4) dispersion of cerebrospinal abbreviation in the heterocysts, cells were large, and the cytoplasm was rich and basophilic. Cell nucleus appeared circular, and the chromatin was exquisite where small lymphocytes were observed.

Enhanced MR scan indicated patchy abnormal enhancement shadow in the right frontal lobe with irregular margin (Fig. 5). This patient chose chemotherapy and died 6 weeks later.

Female, 54 years old, who had a clear history of lung cancer was diagnosed with moderately differentiated adenocarcinoma on November 12, 2013, in Peking Union Medical College Hospital. Pathological changes showed a large amount of micropapillary adjacent to the tunica. EGFR Exon19 deletion mutations were detected. When the patient was hospitalized on August 13, 2014, multi-bone metastases, metastatic carcinoma to the spleen, multiple metastatic carcinoma to the liver, and urinary tract infection were seen. The patient received chemotherapy cycles in the Hematology Department. The onset of the disease was initiated by headache and nausea.

Cerebrospinal abbreviation findings of tumor cells indicated (Fig. 6) cluster arrangement with circular shape and in large volume. The cytoplasm was rich in fine granules, slightly basophilic and translucent, with a few vacuolus. The nuclear egg was circular and off-normal. The nuclear membrane was obvious, and the karyosome was uniformly distributed in the form of fine granules. Inclusion bodies were clearly observed in the nucleus.

Strip-shape enhancement of cerebellum and occipital sulus observed by enhanced MR scan (Fig. 7). This patient was treated with Gefitinib tablet and died 4 months later.