title: Gallbladder carcinoma cells in cerebrospinal fluid as the first manifestation of a tumor. A case report.
abstract: BACKGROUND
  Meningeal carcinomatosis (MC) rarely occurs as the first evidence of a tumor. In such cases cytology of the cerebrospinal fluid is crucial to the diagnosis. The most frequent primary MCs are lung and breast cancers. MC from a gallbladder carcinoma is uncommon.
  
  
  METHODS
  A 58-year-old woman presented with paroxysmal headaches, seizures and coma. Analysis of the cerebrospinal fluid revealed carcinoma cells and a low protein concentration. Only postmortem examination discovered gallbladder adenocarcinoma to be the source of the tumor cells.
  
  
  CONCLUSIONS
  A case with the onset of MC secondary to rare mucinous adenocarcinoma of the gallbladder is presented. Cytology of the cerebrospinal fluid was the only examination that uncovered malignancy. Nine similar cases were found in the literature. Low cerebrospinal fluid protein seems to be of diagnostic value.
authors.affiliation: Department of Neurology, Second Medical Faculty, Charles University, Motol Hospital, V Uvalu 84, 150 18 Prague 5, Czech Republic. libuse.glosova@lfmotol.cuni.cz
authors.forename: Libuse
authors.initials: L
authors.lastname: Glosová
authors.forename: Pavel
authors.initials: P
authors.lastname: Dundr
authors.forename: Josef
authors.initials: J
authors.lastname: Effler
authors.forename: Marie
authors.initials: M
authors.lastname: Růzicková
mesh_terms: D000230:Adenocarcinoma / Q000134:cerebrospinal fluid / Q000556:secondary*; D018395:CA-19-9 Antigen / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D002555:Cerebrospinal Fluid / Q000166:cytology*; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis / Q000378:metabolism; D003128:Coma / Q000209:etiology / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D005706:Gallbladder Neoplasms / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000473:pathology*; D005911:Gliosis / Q000209:etiology / Q000473:pathology; D005947:Glucose / Q000134:cerebrospinal fluid; D006261:Headache / Q000209:etiology / Q000473:pathology; D006801:Humans; D008577:Meningeal Neoplasms / Q000134:cerebrospinal fluid / Q000556:secondary*; D008578:Meninges / Q000473:pathology*; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D012640:Seizures / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D002556:Cerebrospinal Fluid Proteins; D005947:Glucose