Leptomeningeal Metastasis from Carcinoma Breast: A Case of Unknown to Known

  • Princy S Soman Sri Devaraj Urs Academy of Higher Education and Research centre (Pathology and Sri Devaraj Urs Medical College)
  • Hemalatha A Sri Devaraj Urs Academy of Higher Education and Research centre (Pathology and Sri Devaraj Urs Medical College)
  • Kalyani R Sri Devaraj Urs Academy of Higher Education and Research centre (Pathology and Sri Devaraj Urs Medical College)
  • Lakshmaiah V Sri Devaraj Urs Academy of Higher Education and Research centre (Pathology and Sri Devaraj Urs Medical College)
Keywords: Leptomeningeal metastasis, carcinoma breast, meningitis

Abstract

Leptomeningeal metastasis is known to occur as an initial presentation in solid tumors. The presentation of meningeal symptoms before the diagnosis of primary tumor is seen in 10-20% cases. Though the sophisticated radiological imaging is available, Cerebrospinal Fluid (CSF) analysis for tumor cells remains the gold standard method for diagnosis. Incidence of brain metastasis from primary carcinoma breast is about 3-8% only. We present a case of young female who presented with neurological symptoms and misdiagnosed as meningitis on Magnetic Resonance Imaging (MRI), but later after CSF analysis it was diagnosed as metastases from carcinoma breast.

References

Pan Z, Yang G, He H,Yuan T, Wang Y, Li Y et al. Leptomeningeal metastasis from solid tumors: clinical features and its diagnostic implication. Sci. Rep 2018; 8:1-13.

Witzel I, Ferrer L O, Pantel K, Muller V and Wikman H. Breast cancer brain metastases: biology and new clinical perspectives. Breast Cancer Research 2016; 18:8 1-9

Niwinska A, Rudnicka H, Murawska M. Breast cancer leptomeningeal metastasis: propensity of breast cancer subtypes for leptomeninges and the analysis of factors influencing survival. Med Oncol 2013;30: 408.

Polyzoidis KS, Miliaras G, Pavlidis N. Brain metastasis of unknown primary: a diagnostic and therapeutic dilemma. Cancer Treat Rev 2005; 31: 247–55.

Niwinska A, Murawska M, Pogoda K. Breast cancer brain metastases: differences in survival depending on biological subtype, RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT). Ann. Oncol 2010; 21:942-8.

Rhun EL, Preusser M, Bent MV, Andratschke N, Weller M. How we treat patients with leptomeningeal metastases. ESMO open 2019; 4:507-9.

Li X, Zhang Y, Ding J, Wang M, Li N, Yang H et al. Clinical significance of detecting CSF-derived tumor cells in breast cancer patients with leptomeningeal metastasis. Oncotarget 2018; 9:2705-14.

Ahn S, Lim K S. Three Cases of Neoplastic Meningitis Initially Diagnosed with Infectious Meningitis in emergency department. Case Rep Emerg Med 2013; 10:1-4.

Cheng X, Hung MC. Breast cancer brain metastases. Cancer Metastasis Rec 2007; 26: 635–43.

Leal T, Chang JE, Mehta M, Robins HI. Leptomeningeal Metastasis: Challenges in Diagnosis and Treatment. Curr Cancer Ther Rev 2011; 7: 319–27.

Ning M, Chunhua M, Rong J, Yuvan L, Jinduo J, Bin W et al. Diagnostic value of circulating tumor cells in cerebrospinal fluid. Open Med 2016;11: 21-24.

Nayar G, Ejikema T, Chongsathidkiet P, Elsamadicy AA, Blackwell K L, Clarke J M et al. Leptomeningeal disease: current diagnostic and therapeutic strategies. Oncotarget 2017; 8: 73312-28.

Published
2021-03-31
Section
Case Report