Primary diffuse leptomeningeal sarcoma with rhabdomyoblastic differentiation. A case report and immunohistochemical study.
Primary meningeal neoplasias are rare, and their diffuse growth within the subarachnoid space may simulate inflammatory processes or metastatic neoplastic dissemination. We report here the case of a boy with an 18-day history of fever and progressive neurological deterioration. While in the hospital, the patient showed neurological deterioration and did not respond to antituberculosis treatment. His cerebrospinal fluid (CSF) cytology disclosed an elevated white blood cell count accompanied by a mildly elevated protein level and a slightly decreased glucose level. The child died, and pathology revealed that his meningeal process was a sarcoma. The immunophenotype of the neoplastic cells showed expression of a sarcomeric actin marker, characterizing rhabdomyoblastic differentiation of the cells that occupied the subarachnoid space and invaded superficially the encephalon. Rhabdomyoblastic differentiation in leptomeningeal diffuse primary sarcoma (LDPS) is an aspect rarely observed in this malignant meningeal neoplasia, with few reported cases. The present case is the first reported in the Portuguese literature and the fifth reported in the English literature.
de Oliveira
Marcelo José
MJ
Department of Infectology, Federal University of Rio Grande do Norte (UFRN), Rua Governador José Varela, 2887, Cidade Jardim, Natal, RN, CEP 59078-300, Brazil. marcelojoliveira@uol.com
Ramos
Ana Maria de Oliveira
AM
Sales
Alexandre de Oliveira
Ade O
Rolim
Maria Lucemere Motta
ML
de Sousa
Claudia Inês Guerra
CI
Morais
Dalvaci da Conceição Pinheiro
Dda C
D001344:Autopsy; D002648:Child; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology*; D012206:Rhabdomyolysis / Q000473:pathology*; D012509:Sarcoma / Q000473:pathology*; D013346:Subarachnoid Space / Q000473:pathology