A Case of Meningeal Carcinoma from Gastric Cancer in which Intrathecal Chemotherapy Resulted in Symptom Relief and Prolonged Survival

Abstract

The patient was a 66-year-old male. Distal gastrectomy (D2 dissection) was performed for lower-body type 3 gastric cancer. Histopathology revealed L, Post, Type3, 70×60 mm, por2, pT4a, int, INFc, ly3, v1, pN3a (8/20), pPM0 (25 mm), pDM (50 mm), CY0, StageⅢC. Postoperative adjuvant chemotherapy (Tegafur/Gimeracil/Oteracil; TS-1^®) was administered for one year. There was no apparent recurrence until one year eight months after the surgery, when the patient presented with headaches, dizziness, vomiting, nausea, blacking out in the right eye, and double vision. Although a head CT/MRI revealed no obvious abnormalities, the findings of cerebrospinal fluid examination led to the diagnosis of meningeal carcinoma secondary to gastric cancer. A ventriculo-peritoneal shunt (hereinafter, VP shunt) was placed and administration of methotrexate (hereinafter, MTX) into the medullary cavity through the shunt was initiated. The patient’s symptoms improved and it became possible for him to return to work. Meningeal carcinoma from gastric cancer is rare and the prognosis is said to be very poor. Herein, we report a patient, along with a review of the pertinent literature, who showed a relatively prolonged survival of 11 months from the onset of intracranial hypertension among patients with meningeal carcinomatosis.