A Case of Meningeal Carcinomatosis Occurred With a 17-year

抄録・要旨

　A case of 79-year old woman diagnosed as metastatic　recurrence of breast cancer in a form of meningeal　carcinomatosis is reported. The relapse in this　patient occurred after a 17-year disease-free period　after the treatments by surgery and chemo- and endocrine　therapies against the primary and metastases.　Neurological symptoms included sequential bilateral　hearing loss which occurred abruptly and progressed rapidly in 2-3 days, and transient but repeated facial　paralysis and syncope attacks. Diagnosis of meningeal　carcinomatosis was based upon the clinical　symptoms including nuchal rigidity and such results　of laboratory tests and examinations as elevated cerebrospinal fluid（CSF）pressure, lymphocyte-predominant　high CSF cell number, positivity of tumor　markers, which showed higher titers in CSF than　in peripheral blood, and enhanced brain surface image　by gadolinium-enhanced MRI examination, but negative for CSF cytology. Chemo-endocrine therapy　with capecitabine and tamoxifen in combination with　intrathecal administration of methotrexate, cytarabine　and dexamethasone against acute clinical deterioration　had only temporal effect, but the patient deceased　after a very short course by abrupt respiratory　arrest. Survival period of breast cancer patients　prolonged and is expected to prolong more owing to the improvement of endocrine and chemotherapy.　Meningeal carcinomatosis in breast cancer patients　is a rare but possible form of metastatic recurrence,　and should be taken into consideration as a possible　cause of neurological symptoms.