Rapidly developing leptomeningeal carcinomatosis following anterior skull base surgery: a case report.
Leptomeningeal carcinomatosis is rare in evolution of head and neck cancers. Prognosis is poor and treatment is through supportive care. We report an atypical rapid post-operative leptomeningeal carcinomatosis after skull base resection for an ethmoidal adenocarcinoma. The anterior skull base resection was near-total and we suspect a seeding of subarachnoid space either before surgery, either during surgical extirpation or from the residual intracranial nodule. It is the first description of rapid LMC after surgery (less than 1 month). Post-operative MRI diagnosed the LMC through the detection of contrast enhancing leptomeningeal nodules at bilateral second and eighth cranial nerves and at bilateral interpedoncular area. A strong index of suspicion along with clinical and radiological correlation is essential to arrive at a correct diagnosis. Otolaryngologists should be aware of the possibility of leptomeningeal carcinomatosis, before or after surgery, in a patient presents with an appropriate constellation of neurologic symptoms and a history of cancer.
Vellin
Jean-François
JF
Department of Otorhinolaryngology and Head Neck Surgery, Gabriel Montpied Teaching Hospital Network, University of Clermont 1, rue Montalembert, F-63000 Clermont-Ferrand, France. jfvellin@chu-clermontferrand.fr
Achim
Viorel
V
Sinardet
Denis
D
Gabrillargues
Jean
J
Mom
Thierry
T
Gilain
Laurent
L
D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D000368:Aged; D035262:Cranial Fossa, Anterior / Q000473:pathology / Q000601:surgery*; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis / Q000556:secondary; D018450:Disease Progression; D005005:Ethmoid Sinus / Q000473:pathology / Q000601:surgery*; D017809:Fatal Outcome; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D009366:Neoplasm Seeding; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000209:etiology; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed