Leptomeningeal carcinomatosis in a patient with metastatic prostate cancer: case report and literature review

• Published in: Surgical neurology 2006-04, Vol.65 (4), p.372-375
• Main Authors: Cone, Lawrence A., Koochek, Kamran, Henager, Helene A., Fausel, Richard, Gade-Andavolu, Radhika, Potts, Barbara E., Jennings, Lela M.
• Format: Article
• Language: English
• Subjects: Aged; Anti-Inflammatory Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Arachnoid - pathology; Biological and medical sciences; Bone Neoplasms - secondary; Carcinoma - drug therapy; Carcinoma - radiotherapy; Carcinoma - secondary; Consciousness Disorders - etiology; Diagnostic Errors - prevention & control; Early Diagnosis; Fatal Outcome; Headache - etiology; Humans; Leptomeningeal metastases; Lymph Nodes - pathology; Magnetic Resonance Imaging; Male; Medical sciences; Meningeal Neoplasms - drug therapy; Meningeal Neoplasms - radiotherapy; Meningeal Neoplasms - secondary; Metastatic prostate cancer; Neoplasm Metastasis - drug therapy; Neoplasm Metastasis - pathology; Neoplasm Metastasis - physiopathology; Neurosurgery; Pia Mater - pathology; Prostate-Specific Antigen - blood; Prostate-Specific Antigen - cerebrospinal fluid; Prostatic Neoplasms - pathology; PSA in the CNS in prostate cancer; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Treatment Failure
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2005.08.026

Leptomeningeal metastasis is discovered at autopsy in approximately 5% of patients with systemic cancer. Until recently with the introduction of magnetic resonance imaging (MRI), premorbid diagnosis was extremely difficult. In particular, initial spinal fluid cytology is diagnostic in less than 50% of autopsy-verified patients, although repeated spinal fluid examinations may increase the yield significantly. Leptomeningeal metastasis in metastatic prostate cancer has been reported in only 14 patients previously. We recently studied such a patient and were able to establish a correct diagnosis based solely on the MRI and the presence of an elevated cerebrospinal fluid (CSF) prostate-specific antigen (PSA). Only 3 previous patients with leptomeningeal prostate metastasis have undergone CSF PSA evaluations. We believe that, in such patients, the combination of MRI and CSF studies can overcome the lack of sensitivity of CSF cytology.