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Rare case of pancreatic cancer with leptomeningeal carcinomatosis

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INTRODUCTION: Leptomeningeal arcinomatosis (LC) occurs in 5-8% of cases with solid tumors such as lung, breast and melanoma. LC of pancreas adenocarcinoma is rare. We report a case of unresectable pancreatic cancer that progressed to LC, despite maintaining good oncological, clinical and radiological disease control, as well as a significant reduction in plasma tumor markers, with no evidence of local progression.
CASE REPORT: Male patient, 58 years old, followed up at the Oncology Department of IMIP (Instituto de Medicina Integral Professor Fernando Figueira), in Recife/PE, due to metastatic pancreatic adenocarcinoma to the liver, lymph nodes and osteoblastic lesions in several vertebral bodies, more evident in L1, without lesions in other organs, since February 2021. In May 2022, he presented with acute left hemiparesis and dysarthria. The cranial resonance showed 6 lesions suggestive of secondary neoplastic implants and the presence of meningeal enhancement. The result of the analysis of the cerebrospinal fluid was 27 cells/mm³ with 80% of lymphocytes and 20% monocytes, proteins: 560mg/dL, glucose: 10mg/dL. and there was the presence of neoplastic cells. Some of them were shaped like signet rings.
DISCUSSION and FINAL COMMENTS: Particularly, in patients with pancreatic cancer, the development of central nervous system metastases is rare is rare (occurring in approximately 0.3% of cases). This case is remarkable in two ways. First, only 15 cases of LC in pancreatic cancer have been published so far. Second, neoplastic cells were seen in the first lumbar puncture. The diagnosis of LC is difficult in most patients because this requires the detection of malignant cells on CSF cytology. They are detected in the initial CSF sample in only 50% of patients with LC. Repeat CSF analysis has been found to improve the yield to 90%.

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