A Case of Leptomeningeal Carcinomatosis presenting as Loss of Eyesight 2 Years after Total Gastrectomy for Gastric Cancer

Amane Takahashi, Taira Kinoshita, Masaru Konishi, Toshio Nakagohri, Shinichiro Takahashi and Naoto Gotohda

Division of Upper Abdominal Surgical Oncology, National Cancer Center Hospital East

A 62-year-old man suffering from a loss of eyesight and neck pain 2 years after total gastrectomy for gastric cancer had elevated serum CA19-9 but no signs of recurrent disease in imaging examinations. As symptoms worsened, the man underwent cerebrospinal fluid (CSF) cytology to confirm leptomeningeal carcinomatosis, which proved negative (class II). Subsequent brain and cranial nerve symptoms such as blindness, headache, seizures, and mental disturbance rapidly worsened and the patient died 4 months after symptom appearance. Autopsy showed small nodules of the dura mater diagnosed histologically as moderately to poorly differentiated adenocarcinoma. Carcinoma had also infiltrated the cerebral hemispheres, cerebellum, medulla oblongata, and spinal cord. Histologically, carcinoma had infiltrated the optic nerve, causing the loss of eyesight. Even though leptomeningeal carcinomatosis is uncommon in patient with gastric carcinoma, the possibility of leptomeningeal carcinomatosis should be kept in mind and, in this respect, we found repeated CSF cytology to be essential in confirming a definitive diagnosis.

Key words
leptomeningeal carcinomatosis, loss of eyesight, gastric cancer

Reprint requests
Amane Takahashi Division of Upper Abdominal Surgical Oncology, National Cancer Center Hospital East
6-5-1 Kashiwanoha, Kashiwa, 277-8577 JAPAN

Accepted
September 24, 2008

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