Three Cases of Carcinomatous Meningitis following Gastric Cancer Surgery

Abstract

Carcinomatous meningitis is a comparatively rare condition. It occurs in approximately 4% of all cancer patients and has an extremely poor prognosis, with mean survival of approximately 1 month. The cases of three patients who developed carcinomatous meningitis after gastric cancer surgery are presented. Case 1 : A 65-year-old man had undergone distal gastrectomy (por, p-T4aN3bCY1M1 Stage IV). One year 8 months postoperatively, he developed nausea, vomiting, and disturbance of consciousness, and carcinomatous meningitis was diagnosed by cranial contrast-enhanced magnetic resonance imaging (MRI). He died on post-admission Day 24. Case 2 : A 60-year-old man had undergone total gastrectomy (sig, p-T2N0M0 Stage IB). Five years 5 months postoperatively, he developed nausea and vomiting, and cerebellar metastasis was apparent on cranial computed tomography (CT). Carcinomatous meningitis was diagnosed by contrast-enhanced MRI, and he died on post-admission Day 14. Case 3 : A 73-year-old man had undergone total gastrectomy (sig, p-T3N3bM0 Stage IIIB). Four months postoperatively, he developed nausea and vomiting. Cranial CT showed ventricular enlargement, and carcinomatous meningitis was diagnosed by cerebrospinal fluid puncture. He died on post-admission Day 10. Cerebrospinal fluid testing is essential for the definitive diagnosis of carcinomatous meningitis. This condition has a poor prognosis, but immediate diagnostic imaging and cerebrospinal fluid puncture can provide an early diagnosis. Because appropriate treatment improves the patient's quality of life, carcinomatous meningitis should be borne in mind when postoperative vomiting occurs.