title: Rare case of pancreatic cancer with leptomeningeal carcinomatosis.
abstract: Leptomeningeal carcinomatosis occurs very rarely in patients with pancreatic cancer. Leptomeningeal carcinomatosis is characterized by multifocal seeding of the leptomeninges by malignant cells that originate from a solid tumor. To the best of our knowledge, brain metastasis from pancreatic cancer is extremely rare. Leptomeningeal carcinomatosis is estimated to occur in 3% to 8% of cases of solid tumors. The clinical manifestation usually involves neurological symptoms, including dizziness, headache, vomiting, nausea, and hemiparesis, symptoms similar to those of meningitis or brain tumors. Diagnostic methods for leptomeningeal carcinomatosis include brain magnetic resonance imaging and cerebrospinal fluid examination. Here, we describe a case of leptomeningeal carcinomatosis in which the primary tumor was later determined to be pancreatic cancer. Brain magnetic resonance imaging findings showed mild enhancement of the leptomeninges, and cerebrospinal fluid cytology was negative at first. However, after repeated spinal taps, atypical cells were observed on cerebrospinal fluid analysis and levels of tumor markers such as carbohydrate antigen 19-9 in cerebrospinal fluid were elevated. Abdominal computed tomography, performed to determine the presence of extracerebral tumors, revealed pancreatic cancer. Pancreatic cancer was confirmed histopathologically on examination of an endoscopic ultrasound-guided fine needle aspiration specimen.
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: In Kyung
authors.initials: IK
authors.lastname: Yoo
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Chang Duk
authors.initials: CD
authors.lastname: Kim
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Hoon Jai
authors.initials: HJ
authors.lastname: Chun
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Yoon Tae
authors.initials: YT
authors.lastname: Jeen
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Kim
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Hyuk Soon
authors.initials: HS
authors.lastname: Choi
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Lee
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Seung Han
authors.initials: SH
authors.lastname: Kim
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Seung Joo
authors.initials: SJ
authors.lastname: Nam
authors.affiliation: In Kyung Yoo, Hong Sik Lee, Chang Duk Kim, Hoon Jai Chun, Yoon Tae Jeen, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Jae Min Lee, Seung Han Kim, Seung Joo Nam, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Hyun
mesh_terms: D000230:Adenocarcinoma / Q000134:cerebrospinal fluid / Q000150:complications / Q000532:radiotherapy / Q000556:secondary*; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000134:cerebrospinal fluid; D016371:Cranial Irradiation; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D055756:Meningeal Carcinomatosis / Q000134:cerebrospinal fluid / Q000150:complications / Q000532:radiotherapy / Q000556:secondary*; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011237:Predictive Value of Tests; D012640:Seizures / Q000209:etiology; D014057:Tomography, X-Ray Computed
chemical_list: D018395:CA-19-9 Antigen
keywords: Leptomeningeal carcinomatosis; Pancreatic cancer; Prognosis; Radiation therapy; Tumor marker