Dysphagia as the Presenting Symptom of Lung Adenocarcinoma Accompanied with Meningeal Carcinomatosis: A Case Report

Abstract

Meningeal carcinomatosis (MC) is a rare condition with poor prognosis. In this study, we report a case of MC secondary to lung adenocarcinoma presenting with dysphagia. Using a combination therapy of radiation, gefitinib, and dysphagia rehabilitation, the patient eventually achieved full transition from tube feeding to oral feeding. A 72-year-old woman experienced difficulty in swallowing. Dysphagia developed over 3 weeks, resulting in dehydration. On admission, neurological examination revealed dysphagia and diplopia.

Chest computed tomography (CT) and CT-guided cytology revealed lung adenocarcinoma, while brain magnetic resonance imaging indicated MC. Whole-brain radiation was initially performed followed by administration of gefitinib through a percutaneous endoscopic gastrostomy tube. Dysphagia gradually improved, and direct swallowing training was initiated after videofluoroscopic examination of swallowing. Finally, she was able to eat soft food with some assistance. MC should be considered as the differential diagnosis in cases of rapidly deteriorating cranial nerve palsy following dysphagia. Swallowing function recovered in this case, possibly because gefitinib may have been particularly effective.

Detailed evaluation of the patient’s condition should be conducted during the course of treatment for MC, and it is important to appropriately respond, particularly when dysphagia shows an improving trend.