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. 2019 May;10(5):506-510.
doi: 10.3892/mco.2019.1820. Epub 2019 Mar 5.

Meningeal carcinomatosis from bladder cancer: A case report and review of the literature

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Meningeal carcinomatosis from bladder cancer: A case report and review of the literature

Yuta Umezawa et al. Mol Clin Oncol. 2019 May.

Abstract

A 66-year-old Japanese male patient was referred to Saitama Medical University International Medical Center for treatment of bladder cancer (clinical stage T2 or higher without metastasis), and underwent radical cystectomy with pelvic lymphadenectomy. The histopathological diagnosis was high-grade urothelial carcinoma (pathological stage T2bN2, ly1, v0) and 2 cycles of adjuvant systemic chemotherapy (gemcitabine plus cisplatin) were administered. At 15 months after the operation, mediastinal and lung hilar lymph nodes and multiple bone metastases were identified on computed tomography imaging. After 3 cycles of the previous regimen as salvage systemic chemotherapy, the lymph node metastases had shrunk and the bone metastases were stable; therefore, further chemotherapy was planned. At 26 days after the initiation of the 4th cycle, the patient felt nausea and lower limb weakness. Spinal and brain magnetic resonance imaging with contrast medium revealed diffuse enhancement at the surface of the spinal cord and brain. In addition, abnormal signal intensity in the subarachnoid space was observed on fluid-attenuated inversion recovery imaging; therefore, the patient was diagnosed with meningeal carcinomatosis (MC). Treatment, including whole-brain radiotherapy, was planned for MC; however, the patient's condition rapidly worsened and he succumbed to the disease 14 days after the diagnosis of MC. The definitive diagnosis of MC was confirmed at autopsy.

Keywords: cancer autopsy; meningeal carcinomatosis bladder.

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Figures

Figure 1.
Figure 1.
Pathological and radiographic images, and the change of laboratory data during the clinical course. (A and B) Histopathological images of the bladder following radical cystectomy (A, magnification, ×20; B, ×400 magnification of the square in A). Tumor cells infiltrated the bladder muscle layer (blue arrowheads in A), and invaded lymphatic vessels (yellow arrowhead in B). (C and D) Pathological images of brain at autopsy (C, magnification, ×20; D, ×400 magnification of the square in C). Tumor cells infiltrated the subarachnoid space and cerebral sulcus (arrowheads). (E) Chest computed tomography images with enhancement showing lymph node metastasis in the mediastinum (arrowhead). (F) Bone scan image at 15 months after cystectomy showing multiple bone metastases. (G and H) Brain magnetic resonance imaging at diagnosis of meningeal carcinomatosis (G, post-contrast T1-weighted image; H, FLAIR image). The arrowheads indicate (G) abnormal enhancement of the brainstem surface and cerebellar fissure and (H) diffuse abnormal high signal intensity in the subarachnoid space; hydrocephalus is also observed. (I) Change in laboratory data during the clinical course of the disease. Red and blue lines show changes in serum ALP and LDH levels, respectively. Red and blue dotted lines show the upper limit of normal for serum ALP (338 U/l) and LDH levels (211 U/l), respectively. *, Duration of adjuvant chemotherapy; **, duration of salvage chemotherapy. ALP, alkaline phosphatase; LDH, lactate dehydrogenase.

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