PP58. CLINICAL AND RADIOLOGICAL FEATURES OF LEPTOMENINGEAL METASTASES

• Published in: Neuro-oncology (Charlottesville, Va.) Va.), 2017-01, Vol.19 (suppl_1), p.i16-i16
• Main Authors: Pfeifer, Dr Ester, Rees, Dr Jeremy
• Format: Article
• Language: English
• Subjects: Abstracts
• ISSN: 1522-8517; 1523-5866
• DOI: 10.1093/neuonc/now293.058

INTRODUCTION: Leptomeningeal metastases (LM) is an uncommon complication of cancer and is associated with a variety of different clinical presentations. AIM: The aim of this study was to assess clinical, radiological, and survival data in all cases of LM identified by cytological examination of cerebrospinal fluid (CSF) at the University College London Hospital Foundation Trust between 2010 and 2016. METHODS: CSF cytology reports from 2010–2016 were analysed and patients with malignant cells in CSF were identified. Those with positive CSF cytology as part of staging investigations for primary central nervous system (CNS) tumours and high grade lymphomas were excluded. Clinical, biochemical and magnetic resonance imaging (MRI) data were obtained for the confirmed cases from the Electronic Patient Record. RESULTS: Twenty patients (M:F 15:5) out of 4424 patients (0.5%) were identified as positive for malignant cells. All had been previously diagnosed with cancer of the breast (n=11), lung (n=7), bladder, oesophagus and neuroendocrine tumour (1 each). Two of the patients with breast cancer had a second primary tumour (melanoma and meningioma) and two patients with lung cancer also had a history of breast cancer. Median survival after diagnosis was 32 days (range 5–273 days, n=16). Only two patients, both with breast cancer, survived more than three months; both had normal imaging at diagnosis. The patient with longest survival had CSF taken as part of a dementia workup and found to have malignant cells. 3 patients died within 2 weeks of diagnosis. Clinical presentations were cognitive decline (n=8), of whom 5 presented with additional symptoms including headache, gait disturbance and limb weakness, hydrocephalus (n=6), radiculopathy (n=3), severe headache (n=2), or headache with cranial nerve palsies (n=1). Contrast-enhanced MRI of the brain showed nodular or linear meningeal enhancement (n=9, of whom 3 also had cerebral metastases), cerebral metastases alone (n=5), subtle meningeal enhancement (n=3) and normal appearances (n=3). Following diagnosis, the 6 patients with hydrocephalus had ventriculoperitoneal shunt insertion and 3 had Ommaya reservoir for intrathecal chemotherapy. CONCLUSIONS: In this small series, LM presented in a variety of ways and only occurred in patients with known cancer. All but two patients died within two months. MRI was highly suggestive of LM in less than half the patients.