Abstract
Background. Meningeal carcinomatosis is a complication of lung cancer. However, many patients have metastatic disease other than in the meninges. Cases of early non-small-cell lung cancer have a low rate of recurrence 4 years after surgery. We experienced a case of epidermal growth factor receptor (EGFR) gene mutation-positive early lung adenocarcinoma that recurred 12 years postoperatively with meningeal carcinomatosis alone. Case. A 77-year-old woman visited our hospital because of forgetfulness and difficulty walking. There were no abnormalities on brain contrast-enhanced magnetic resonance imaging. Cerebrospinal fluid cytology detected adenocarcinoma cells and confirmed an EGFR gene mutation (L858R). No neoplastic lesions other than in the meninges were found. The resected specimen of lung adenocarcinoma, which had been removed 12 years ago, showed the same EGFR gene mutation (L858R) as the adenocarcinoma cells on cerebrospinal fluid cytology. We diagnosed her with lung adenocarcinoma that recurred postoperatively with meningeal carcinomatosis alone. Her symptoms improved with the administration of erlotinib. Conclusion. Cases with neurological symptoms, such as cognitive decline, that worsen after surgery for lung cancer should be considered for a cerebrospinal fluid examination under suspicion of meningeal carcinomatosis, even if there are no abnormalities on imaging tests.
