A Case of Lung Cancer with Diffuse Leptomeningeal Carcinomatosis: An Inquiry into the Route of Spreads to Meninges

Abstract

A 54-year old woman was hospitalized with chief complaints of loss of consciousness and vomiting. Physical examination, chest X-ray findings and radiographic bone survey established the diagnosis of lung cancer with metastases to the leptomeninges, the left pleura, and the vertebrae. At autopsy, a primary lesion of adenocarcinoma was identified in the L. U. L., and metastatic involvement was confirmed in the meninges of the spinal cord, the brain, the left pleura and the vertebrae. Microscopic sections of the nerve root of the spinal cord revealed infiltrations of tumor cells into the vertebral veins. According to the result of our study on 191 autopsied cases of lung cancer, the incidence of meningeal metastasis is about one tenth on the incidence brain metastasis, suggesting that the route to the meninges is different from that to the brain. From the fact that one or two of all of either vertebral, peritoneal or pleural metastasis were found in cases with menigeal metastasis and from the fact that there were infiltrations of tumor cells into the vertebral veins, it is emphasized that the importance of the vertebral vein as a metastatic route to the meninges can not be too much stressed.