title: Leptomeningeal carcinomatosis in gastric cancer.
abstract: We analyzed 19 cases of cytologically confirmed leptomeningeal carcinomatosis (LMC) treated at our institution over the past 11 years. LMC was the initial manifestation of gastric cancer in 2 patients. With the exception of 1 patient, the primary gastric cancer was Borrmann type III or IV, and 88% had poorly differentiated or signet-ring cell histology. The gastric cancer was progressive or a recurrent disease in most of the patients. The distribution of extraneural metastasis suggested that Batson's venous plexus might be the predominant route to the subarachnoid space. Eighty percent of the patients had multiple neuraxis syndrome, and the combination of brain plus cranial nerve syndrome was the most common manifestation. Computed tomography (CT) findings were abnormal in a minor proportion of the patients, while magnetic resonance imaging (MRI) revealed abnormality in 67% of the patients, which could help the diagnosis. LMC complicating gastric cancer was ultimately fatal. Median survival was very short, 4 weeks. By univariate analysis, good performance status, intrathecal chemotherapy, and low CSF LDH concentration favored survival. Multivariate analysis revealed that the administration of CSF chemotherapy was the independent prognostic factor for survival.
authors.affiliation: Department of Medicine, Division of Oncology-Hematology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Jae-Lyun
authors.initials: JL
authors.lastname: Lee
authors.forename: Yoon-Koo
authors.initials: YK
authors.lastname: Kang
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kim
authors.forename: Heung-Moon
authors.initials: HM
authors.lastname: Chang
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
authors.forename: Min-Hee
authors.initials: MH
authors.lastname: Ryu
authors.forename: Eunkyoung
authors.initials: E
authors.lastname: Kim
authors.forename: Seok-Joong
authors.initials: SJ
authors.lastname: Oh
authors.forename: Je-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Sung-Bae
authors.initials: SB
authors.lastname: Kim
authors.forename: Sang-We
authors.initials: SW
authors.lastname: Kim
authors.forename: Cheolwon
authors.initials: C
authors.lastname: Suh
authors.forename: Kyoo-Hyung
authors.initials: KH
authors.lastname: Lee
authors.forename: Jung-Shin
authors.initials: JS
authors.lastname: Lee
authors.forename: Woo-Kun
authors.initials: WK
authors.lastname: Kim
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D003390:Cranial Nerve Neoplasms / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D016609:Neoplasms, Second Primary / Q000473:pathology*; D009422:Nervous System Diseases / Q000209:etiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed