Two cases of meningeal carcinomatosis secondary to gastric carcinoma in which cerebrospinal fluid cytology proved useful for the diagnosis

Abstract

Background : Gastrointestinal tract cancer is a rare cause, among solid tumors, of meningeal carcinomatosis (MC). We report two cases of gastric cancer, in which meningitis was suspected symptomatically, and the diagnosis of MC was confirmed by cerebrospinal fluid (CSF) cytology.

Cases : Case 1 was a man in his 60s who underwent gastrectomy followed by chemotherapy for advanced gastric cancer. He complained of headache and gait disturbance 7 months later, and was diagnosed with vertebral metastasis. Suspecting of meningitis, cytology of the CSF revealed atypical cells suggestive of adenocarcinoma. Case 2 was a man in his 80s who underwent gastrectomy for early gastric cancer, but was diagnosed 3 years later with another early cancer involving the remnant, which was resected endoscopically. Six months thereafter, he was hospitalized for generalized weakness, became comatose about a week after admission, and was suspected as having meningitis. Cytology of the CSF disclosed signet ring cell like atypical cells.

Conclusion : Gastric cancer rarely causes MC, but MC can occur in advanced or early stages of poorly differentiated adenocarcinoma and signet ring cell carcinoma. In gastric carcinoma patients with signs of meningeal irritation after surgery, CSF cytology is useful for early diagnosis of MC.