Leptomeningeal carcinomatosis in a patient with metastatic prostate cancer: case report and literature review.
BACKGROUND
Leptomeningeal metastasis is discovered at autopsy in approximately 5% of patients with systemic cancer. Until recently with the introduction of magnetic resonance imaging (MRI), premorbid diagnosis was extremely difficult. In particular, initial spinal fluid cytology is diagnostic in less than 50% of autopsy-verified patients, although repeated spinal fluid examinations may increase the yield significantly. Leptomeningeal metastasis in metastatic prostate cancer has been reported in only 14 patients previously.


METHODS
We recently studied such a patient and were able to establish a correct diagnosis based solely on the MRI and the presence of an elevated cerebrospinal fluid (CSF) prostate-specific antigen (PSA). Only 3 previous patients with leptomeningeal prostate metastasis have undergone CSF PSA evaluations.


CONCLUSIONS
We believe that, in such patients, the combination of MRI and CSF studies can overcome the lack of sensitivity of CSF cytology.
Cone
Lawrence A
LA
Department of Medicine, Eisenhower Medical Center, Rancho Mirage, CA 92270, USA. laconemedico@aol.com
Koochek
Kamran
K
Henager
Helene A
HA
Fausel
Richard
R
Gade-Andavolu
Radhika
R
Potts
Barbara E
BE
Jennings
Lela M
LM
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001099:Arachnoid / Q000473:pathology*; D001859:Bone Neoplasms / Q000556:secondary; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D003244:Consciousness Disorders / Q000209:etiology; D003951:Diagnostic Errors / Q000517:prevention & control; D042241:Early Diagnosis; D017809:Fatal Outcome; D006261:Headache / Q000209:etiology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D009362:Neoplasm Metastasis / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D010841:Pia Mater / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood / Q000134:cerebrospinal fluid; D011471:Prostatic Neoplasms / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
D000893:Anti-Inflammatory Agents; D017430:Prostate-Specific Antigen