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Metastatic Cervical Carcinoma with Evolution to Encephalic Meningeal Carcinomatosis

RESUMO

Case Presentation: Female patient, 38 years old, smoker, diagnosed with stage IIIB squamous cell carcinoma of the cervix in 2019, underwent radiotherapy until February 2020 and after started brachytherapy. During the follow-up, the patient presented progression of the disease to the peritoneum, lung, ribs and dorsal spine, and underwent to palliative chemotherapy with carboplatin and plalaclitaxel. In September 2020, had a hospital admission due to severe holocranial headache, fatigue, dysuria, diarrhea, pain in the lumbar region and episodes of fever. Cranioencephalic MRI revealed the presence of multiple contrast-enhanced nodular lesions in the skullcap, compatible with metastatic implants, some causing erosion of the inner bone plate, with thickening and diffuse pachymeningeal enhancement, more evident in the right frontal region, which could be related to pachymeningeal carcinomatosis. Also, the presence of minute nodular images with hypersignal in FLAIR and weak contrast enhancement, located along the leaves of the middle third of the right cerebellar hemisphere, may be related to leptomeningeal or intraparenchymal cortico-subcortical implants. In addition, it was detected small hyperintense T2/FLAIR images in the supratentorial white matter, with no expansive effect, diffusion restriction or contrast enhancement. Other imaging exams revealed the extent of metastatic involvement to the liver, adrenals and mandible. Treatment was ceased due to terminality of the patient, and was kept in exclusive comfort. The patient died a few days later.
Discussion: There are less than 22 articles published in the literature that describe meningeal carcinomatosis related to gynecological cancers. It is estimated that the incidence of meningeal carcinomatosis in patients with cervical cancer is 0.03%. Patients with meningeal carcinomatosis have a poor prognosis due to the advanced stage of the primary tumor. Literature data indicate that the median survival after diagnosis ranges from 10 days to 26 weeks.
Final Comments: Meningeal carcinomatosis related to cervical carcinoma is rare. However, this pathology should be considered in patients with primary gynecological tumors who present a clinical picture suggestive of CNS involvement, since palliative therapies can be instituted to improve the patient's quality of life and delay neurological deterioration.

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