[Carcinomatous meningitis].
BACKGROUND
Carcinomatous meningitis is a serious complication of advanced stage solid tumours, which may become more common with improved survival.


METHODS
A 53-year-old woman with a recent history of breast cancer (pT2pN2M0) had been treated by mastectomy and adjuvant chemotherapy and radiotherapy. She presented with weakness, diplopia and vertigo raising the possibility of vertebrobasilar ischaemia or an intracranial mass. In another patient, a 62-year-old man with hypertension, a stenotic common bile duct had been diagnosed when examined for abdominal complaints. When he presented with a high blood pressure value accompanied by intensive headache, vomiting and bilateral hearing loss, he was thought to have a hypertensive crisis. The rapidly progressive neurological symptoms and the history of breast cancer and findings suggesting pancreatic head tumour, respectively, led to the clinical diagnosis of carcinomatous meningitis in both cases, despite any evidence on CT scans or a negative MR scan, though of limited value, in the first case. This diagnosis was confirmed by the laboratory and cytological findings of the cerebrospinal fluid, and also by the post mortem examination, since both patients died within a month after the onset of the symptoms. The primary tumour in the second patient proved to be a widely metastasizing diffuse type gastric cancer.


CONCLUSIONS
Carcinomatous meningitis has a varying but characteristic presentation which generally makes it easy to diagnose, but it can sometimes present differential diagnostic problems. What we can learn from these two cases may help in recognizing this complication.
Cserni
Gábor
G
Bács-Kiskun Megyei Onkormányzat Kórháza, Patológiai Osztály, H-6000 Kecskemet, Nyíri. cserni@freemail.hu
Vágó
Tibor
T
Török
Norbert
N
Gaál
Zoltán
Z
Velkei
Tamás
T
Serényi
Péter
P
Göczo
Katalin
K
Tusa
Magdolna
M
Kovács
Katalin
K
Szucs
Miklós
M
D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D002277:Carcinoma / Q000150:complications* / Q000556:secondary; D018270:Carcinoma, Ductal, Breast / Q000150:complications; D003933:Diagnosis; D004172:Diplopia / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D008207:Lymphatic Metastasis; D008297:Male; D055756:Meningeal Carcinomatosis / Q000150:complications / Q000209:etiology*; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D014717:Vertigo / Q000209:etiology; D014839:Vomiting / Q000209:etiology