Shimane Journal of Medical Science

Shimane University Faculty of Medicine
ISSN :0386-5959(in print)
ISSN :2433-2410(online)

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Shimane Journal of Medical Science 28 1
2011-12-01 発行

A Case of Meningeal Carcinomatosis Occurred With a 17-year

Saika, Reiko
Iijima, Kenichi
Bokura, Hirokazu
Oguro, Hiroaki
Yamaguchi, Shuhei
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 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.