A Case of Meningeal Carcinomatosis from Pancreatic Cancer during Chemotherapy using Gemicitabine

Yoshikazu Yagi, Yasuaki Nishimura¹⁾, Shigekazu Nakatsugawa²⁾, Tomoki Fukuoka, Masashi Hirota, Kiichiro Okamoto, Tsuyoshi Sato and Tohru Ichihara

Department of Surgery, National Hospital Organization Toyohashi Hospital
Department of Neurosurgery, National Hospital Organization Toyohashi East Hospital¹⁾
Department of Radiology, Nagoya University School of Medicine²⁾

A 64-year-old man treated for diabetes mellitus came to our hospital in January 2004 complaining of left hypochondriac pain of about one month's duration. Abdominal US revealed a tumor in the body of the pancreas over 4cm in size. The serum CEA and CA19-9 levels were elevated. ERP revealed the occlusion of the main pancreatic duct in the region of the pancreatic body. Abdominal CT and abdominal angiography showed that the pancreatic tumor involved the celiac artery, splenic artery, common hepatic artery, superior mesenteric artery, superior mesenteric vein, splenic vein, and portal vein. We therefore made diagnosis of unresectable cancer of the pancreatic body, and gemcitabine chemotherapy was started in February. In April, the tumor marker levels had become normal and the clinical course was favorable. However, fever, vomiting, and headache suddenly developed, and he was admitted the next day. We diagnosed meningeal carcinomatosis based on the cerebral CT and MRI findings, and radiotherapy was selected to treat the meningeal carcinomatosis, because there was no evidence of metastasis to other organs. The gemicitabine dose was reduced during radiotherapy. As of December 2005, the patient is alive and has continued on gemcitabine chemotherapy.

Key words
meningeal carcinomatosis, pancreatic cancer, gemcitabine

Reprint requests
Yoshikazu Yagi Department of Surgery, Biyo Public Hospital
148 Yamanoura, Jimokuji, Jimokuji-cho, Ama-gun, 490-1111 JAPAN

Accepted
March 22, 2006

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