Diffuse primary leptomeningeal melanocytosis in a patient receiving a novel cancer cell vaccine for prostate cancer.
A 75-year-old man, undergoing treatment for metastatic prostate cancer with a novel cancer cell vaccine, presented with a 4 week history of poor balance, gait disturbance and cognitive decline. Blood tests including HIV and onconeuronal and voltage gated potassium channel antibodies were normal. Computed tomography and two magnetic resonance images of the brain showed possible non-specific meningeal or vascular enhancement. Two cerebrospinal fluid analyses, including cytology, were negative, other than six lymphocytes in the former. Despite intravenous aciclovir and dexamethasone the patient deteriorated over 16 days, with worsening confusion and involuntary movements, and died. Postmortem examination showed that the leptomeninges overlying the brain and spinal cord were diffusely infiltrated by a melanocytosis with a focal area of melanomatosis. Moreover, there were two sites of metastases of a highly malignant clone present in the pulmonary parenchyma.


BACKGROUND
NCT00133224.
Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool L9 7LJ, UK. benedictmichael@doctors.net.uk
Benedict Daniel
BD
Michael
Isabel
I
Syndikus
Alistair
A
Clark
Atik
A
Baborie
D000368:Aged; D019496:Cancer Vaccines; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary*; D008297:Male; D008545:Melanoma / Q000556:secondary*; D008577:Meningeal Neoplasms / Q000556:secondary*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
D019496:Cancer Vaccines