Gallbladder carcinoma cells in cerebrospinal fluid as the first manifestation of a tumor. A case report.
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.
Glosová
Libuse
L
Department of Neurology, Second Medical Faculty, Charles University, Motol Hospital, V Uvalu 84, 150 18 Prague 5, Czech Republic. libuse.glosova@lfmotol.cuni.cz
Dundr
Pavel
P
Effler
Josef
J
Růzicková
Marie
M
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
D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D002556:Cerebrospinal Fluid Proteins; D005947:Glucose