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Wu SA, Jia DT, Schwartz M, Mulcahy M, Guo K, Tate MC, Sachdev S, Kostelecky N, Escobar DJ, Brat DJ, Heimberger AB, Lukas RV. HER2+ esophageal carcinoma leptomeningeal metastases treated with intrathecal trastuzumab regimen. CNS Oncol 2023; 12:CNS99. [PMID: 37219390 PMCID: PMC10410688 DOI: 10.2217/cns-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
Materials & methods: We recently reported the largest trial of breast cancer patients with HER2 positive leptomeningeal metastases (LM) treated with trastuzumab. An additional treatment indication was explored as part of a single institution retrospective case series of HER2 positive esophageal adenocarcinoma LM (n = 2). Results: One patient received intrathecal trastuzumab (80 mg twice weekly) as part of their treatment regimen with durable long-term response and clearance of circulating tumor cells in the cerebral spinal fluid. The other patient demonstrated rapid progression and death as previously described in the literature. Conclusion: Intrathecal trastuzumab is a well-tolerated and reasonable therapeutic option worthy of further exploration for patients with HER2 positive esophageal carcinoma LM. An associative, but not a causal relationship, can be made regarding therapeutic intervention.
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Affiliation(s)
- Scott A Wu
- Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Dan Tong Jia
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Lou & Jean Malnati Brain Tumor Institute, Chicago, IL 60611, USA
| | - Margaret Schwartz
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Lou & Jean Malnati Brain Tumor Institute, Chicago, IL 60611, USA
| | - Mary Mulcahy
- Department of Hematology & Oncology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Kuanghua Guo
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Lou & Jean Malnati Brain Tumor Institute, Chicago, IL 60611, USA
| | - Matthew C Tate
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Sean Sachdev
- Department of Radiation Oncology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Nicolas Kostelecky
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - David J Escobar
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Daniel J Brat
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Amy B Heimberger
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Rimas V Lukas
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Lou & Jean Malnati Brain Tumor Institute, Chicago, IL 60611, USA
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Huang X, Jia Y, Jiao L. Sensorineural Hearing Loss as the Prominent Symptom in Meningeal Carcinomatosis. ACTA ACUST UNITED AC 2021; 28:3240-3250. [PMID: 34449589 PMCID: PMC8395462 DOI: 10.3390/curroncol28050281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/06/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022]
Abstract
Sensorineural hearing loss (SNHL) has been reported rarely in patients with meningeal carcinomatosis (MC). We summarized the clinical data of eight MC patients with SNHL and 35 patients reported from publications. In the eight patients with SNHL, the medium onset age was 48 (range from 37 to 66) years and six (75%) were male. Seven (87.5%) suffered from headaches as the initial symptom, and they experienced SNHL during the first two months after the occurrence of headaches (0.5 to 2 months, average 1.5 months). The audiogram configuration was flat in three patients (37.5%) and showed total deafness in five patients (62.5%). The damage of cranial nerves VI (abducens) was observed in six patients (75%), and four patients (50%) had cranial nerves VII (facial) injury during the disease course. The percentage of damage of cranial nerves was higher than the patients without SNHL (VIth, 75.0% vs. 13.3%, p = 0.002 and VIIth 50.0% vs. 6.7%, p = 0.012). Four (50%) patients suffered from lung adenocarcinoma as primary tumor, two (25%) experienced stomach adenocarcinoma, one had colon cancer, and one patient was unknown. The symptom of SNHL improved after individualized therapy in four patients (focal radiotherapy and chemotherapy for three patients and whole brain radiotherapy for one patient), but all passed away from 2 to 11 months after diagnosis. Total deafness and flat hearing loss in audiogram were the common types of SNHL resulting from MC. MC patients with SNHL were more likely to suffer from the damage of other cranial nerves, especially to cranial nerves VI and VII. Treatment might improve SNHL, but not improve the case fatality rate.
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Alkhotani A, Alrishi N, Alhalabi MS, Hamid T. Cauda Equina Syndrome Secondary to Leptomeningeal Carcinomatosis of Gastroesophageal Junction Cancer. Case Rep Neurol 2016; 8:87-91. [PMID: 27239185 PMCID: PMC4881252 DOI: 10.1159/000445869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Leptomeningeal carcinomatosis (LMC) is a diffuse or multifocal malignant infiltration of the pia matter and arachnoid membrane. The most commonly reported cancers associated with LMC are breast, lung, and hematological malignancies. Patients with LMC commonly present with multifocal neurological symptoms. We report a case of LMC secondary to gastroesopha-geal junction cancer present initially with cauda equina syndrome. A 51-year-old male patient with treated adenocarcinoma of the gastroesophageal junction presented with left leg pain, mild weakness, and saddle area numbness. Initial radiological examinations were unremarkable. Subsequently, he had worsening of his leg weakness, fecal incontinence, and urine retention. Two days later, he developed rapidly progressive cranial neuropathies including facial diplegia, sensorineural hearing loss, dysarthria, and dysphagia. MRI with and without contrast showed diffuse enhancement of leptomeninges surrounding the brain, spinal cord, and cauda equina extending to the nerve roots. Cerebrospinal fluid cytology was positive for malignant cells. The patient died within 10 days from the second presentation. In cancer patients with cauda equina syndrome and absence of structural lesion on imaging, LMC should be considered. To our knowledge, this is the first case of LMC secondary to gastroesophageal cancer presenting with cauda equina syndrome.
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Affiliation(s)
- Amal Alkhotani
- Umm AlQura University, Makkah, Saudi Arabia; King Abdulla Medical City, Makkah, Saudi Arabia
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Ahmed M, Begum T, Omer AR, Khan IA. Leptomeningeal carcinomatosis from oesophageal cancer, presenting as meningitis. BMJ Case Rep 2016; 2016:bcr-2015-210974. [PMID: 26740266 DOI: 10.1136/bcr-2015-210974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 47-year-old woman presented with headache, neck pain, dizziness, nausea and vomiting for 4-5 days. She also had a history of weight loss and difficulty in swallowing. On physical examination, she had nuchal rigidity with a positive Kernig's sign. Cerebrospinal fluid analysis revealed mild pleocytosis but some atypical cells were also noted. Cytopathological analysis of the atypical cells showed high nuclear/cytoplasmic ratios and eccentric nuclei with prominent nucleoli, consistent with malignancy. A CT scan of the head and neck showed multiple lytic lesions involving the left calvarium, and diffuse thickening and enhancement of meninges over the left cerebral area. Extensive osteolytic lesions were also noted on the vertebral bodies, pedicles and lamina, at multiple levels of the cervical spine. An endoscopy revealed a mass at the gastro-oesophageal junction, and biopsy confirmed moderately differentiated adenocarcinoma of the oesophagus. The patient was started on chemotherapy along with radiation therapy.
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Malignant meningitis secondary to oesophageal adenocarcinoma presenting with sensorineural hearing loss: a series of three cases and discussion of the literature. Eur Arch Otorhinolaryngol 2015; 273:2481-6. [DOI: 10.1007/s00405-015-3842-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
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Lukas RV, Mata-Machado NA, Nicholas MK, Salgia R, Antic T, Villaflor VM. Leptomeningeal carcinomatosis in esophageal cancer: a case series and systematic review of the literature. Dis Esophagus 2014; 28:772-81. [PMID: 25142531 DOI: 10.1111/dote.12276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study was to more clearly define the clinical course of leptomeningeal carcinomatosis due to esophageal cancer. A single institution retrospective case series was conducted. Additionally, a systematic review of the literature was performed. We present a large case series (n = 7) of leptomeningeal carcinomatosis due to esophageal cancer. Our case series and systematic review of the literature report similar findings. In our series, we report a predominance of male patients (86%) with adenocarcinoma histology (77%). Variable onset of leptomeningeal involvement of esophageal cancer in relation to the original diagnosis of the primary disease (5 months to 3 years and 11 weeks) was noted. Disease progresses quickly and overall survival is poor, measured in weeks (2.5-16 weeks) from the diagnosis of leptomeningeal involvement. Four of our patients initiated whole-brain radiation therapy with only two completing the course prior to clinical deterioration. Our patient with the longest survival (16 weeks) received intrathecal topotecan and oral temozolomide. Leptomeningeal carcinomatosis secondary to esophageal cancer has a poor prognosis. A clearly beneficial treatment modality is lacking.
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Affiliation(s)
- R V Lukas
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - N A Mata-Machado
- Department of Pediatric Neurology, Loyola University, Chicago, Illinois, USA
| | - M K Nicholas
- Department of Neurology, University of Chicago, Chicago, Illinois, USA.,Department of Surgery-Section of Neurosurgery, University of Chicago, Chicago, Illinois, USA.,Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, USA
| | - R Salgia
- Department of Medicine-Section of Hematology & Oncology, University of Chicago, Chicago, Illinois, USA
| | - T Antic
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - V M Villaflor
- Department of Medicine-Section of Hematology & Oncology, University of Chicago, Chicago, Illinois, USA
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Ohno T, Yokoyama Y, Aihara R, Mochiki E, Asao T, Kuwano H. Sudden bilateral sensorineural hearing loss as the presenting symptom of meningeal carcinomatosis of gastric cancer: report of a case. Surg Today 2010; 40:561-5. [PMID: 20496139 DOI: 10.1007/s00595-009-4099-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 01/08/2009] [Indexed: 01/07/2023]
Abstract
Meningeal carcinomatosis is the diffuse infiltration of the meninges by metastatic carcinoma. A 62-year-old man presented with a sudden onset of profound hearing loss affecting both ears. Brain magnetic resonance imaging showed increased signal intensity on T1-weighted images of both vestibulocochlear nerves. Upper gastrointestinal endoscopy revealed a large type 3 gastric cancer, and the pathological diagnosis was poorly differentiated adenocarcinoma. Although combination chemotherapy with oral S-1 and weekly paclitaxel and radiation therapy were performed, the patient's condition gradually worsened, and he eventually died 12 weeks after the onset of deafness. Isolated bilateral hearing loss is therefore considered to be a rare first manifestation of meningeal carcinomatosis.
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Affiliation(s)
- Tetsuro Ohno
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan
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Leptomeningeal carcinomatosis and sensorineural hearing loss: Correlation of labyrinthine enhancement patterns with symptoms. J Neuroradiol 2009; 36:98-101. [DOI: 10.1016/j.neurad.2008.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kizawa M, Mori N, Hashizume Y, Yoshida M. Pathological examination of spinal lesions in meningeal carcinomatosis. Neuropathology 2008; 28:295-302. [DOI: 10.1111/j.1440-1789.2007.00879.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Leptomeningeal carcinomatosis occurs in approximately 5% of patients with cancer. The most common cancers involving the leptomeninges are breast, lung cancer and melanoma. However, gastric adenocarcinoma has been rarely reported with leptomeningeal carcinomatosis. The presenting manifestations are usually headache, visual disturbances and seizures. We report a case of leptomeningeal metastasis that presented as a gastric cancer. A 49-year-old woman was admitted to our hospital with the symptoms of headache and melena for 10 days. The endoscopy showed a thickening of the folds of the stomach compatible with the diagnosis of a Borrman type IV gastric cancer. The biopsy revealed a signet ring cell carcinoma. The MRI of brain showed no abnormal findings; however, the patient complained of an intractable persistent headache, nausea and vomiting on admission day 6. The cytology examination of the cerebrospinal fluid supported the diagnosis of metastatic signet ring cell carcinoma.
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Affiliation(s)
- Hong Gi Lee
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, Korea.
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Lai TH, Chen C, Yen DJ, Yu HY, Yiu CH, Kwan SY. Isolated acute hearing loss as the presenting symptom of leptomeningeal carcinomatosis. J Chin Med Assoc 2006; 69:496-8. [PMID: 17098676 DOI: 10.1016/s1726-4901(09)70316-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Leptomeningeal carcinomatosis is characterized by diffuse infiltration of the meninges by metastatic cancer. We report a rare case of leptomeningeal carcinomatosis with an initial presentation of isolated acute hearing loss. Progressive unsteady gait and multiple cranial nerve palsies ensued. Computed tomography of the chest with contrast revealed a 2 cm nodule over the right upper lung. Cytology of cerebrospinal fluid confirmed the diagnosis of adenocarcinoma. The patient was discharged after diagnosis. Isolated acute hearing loss is a rare initial presentation in leptomeningeal carcinomatosis, not necessarily with a known history of malignancy. A high index of suspicion is mandatory for accurate diagnosis.
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Affiliation(s)
- Tzu-Hsien Lai
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taiwan, R.O.C
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Baba S, Matsuda H, Gotoh M, Shimada KI, Yokoyama Y, Sakanushi A. A case of meningeal carcinomatosis presenting with the primary symptoms of facial palsy and sensorineural deafness. J NIPPON MED SCH 2006; 73:240-3. [PMID: 16936452 DOI: 10.1272/jnms.73.240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report the case of a 59-year-old man with meningeal carcinomatosis (MC) who presented with peripheral facial palsy and progressive sensorineural deafness. The patient had been operated on for gastric cancer 1 year previously, and no metastases had been detected in the retroperitoneum or thorax at follow-up examination 1 year later. However, he developed headache, deafness, and peripheral facial palsy and was referred to us for further evaluation, as magnetic resonance of the head had shown no abnormalities. Ramsay Hunt syndrome was suspected, but no increase in the cerebrospinal fluid cell count was detected. On the other hand, the balance test suggested a central disorder. In addition, the plasma level of carcinoembryonic antigen suddenly increased, suggesting MC. The cerebrospinal fluid was examined several times; in the end malignant cells and an increase in the cell count were detected, and the diagnosis of MC was established.
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Affiliation(s)
- Shunkichi Baba
- Department of Otolaryngology, Chiba-Hokusoh Hospital, Nippon Medical School, Inba, Chiba, Japan.
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