Dados do Trabalho

Título

Leptomeningeal Neoplastic Syndrome: A case report

RESUMO

Presentation of the Case: E.D.S; female, 65yo, white, smoker (50 pack-years) with consumptive syndrome and report of cognitive decline, behavioral and gait disorders, with a slowly progressive course plus a recent episode of exacerbation and possible diagnosis of Normal pressure hydrocephalus (NPH). The patient presented, in the last 5 months, worsening of the symptoms associated with headache, evolving with dependence for activities of daily living. In addition, he presented hearing deficit with a unilateral sensorineural pattern on the right, in addition to central vestibular dysfunction and left third cranial nerve paresis.
The patient sought care when she was hospitalized and tonic muscle spasms were observed with associated loss of consciousness, in addition to an increase in serum inflammatory and infectious markers and in the cerebrospinal fluid (Hyperproteinorrhaquia with hypoglycorrhachia and slightly increased cellularity; BAAR and GeneXpert negative)
Magnetic resonance imaging showed leptomeningeal enhancement, mild dilatation of the supra and infratentorial ventricular system, associated with signs suggestive of transependymal CSF transudation and ventriculitis.
Computed tomography of the abdomen, pelvis and neck were performed in order to promote neoplastic screening, however the results were normal. Cervical ultrassound showed lymph nodes increased in number in left cervical chains.
A leptomeningeal biopsy was performed and the result consisted of infiltration by atypical cells with the presence of KI67 marker in 100% of the cells of interest. The patient had an unfavorable outcome and died within 1 month.
Discussion: Despite a clinical course suggestive of NPH, the history of smoking and the consumptive syndrome, associated with diffuse meningeal manifestation and characteristic cerebrospinal fluid profile, showed a probable neoplastic syndrome in the central nervous system, associated with the KI67 marker, which is more frequently expressed in upper respiratory tract epidermoid carcinomas
Final comments: The presence of hypoglycorrhachia in the diagnostic context of meningoencephalitis should expand the possibilities of differential diagnosis, with neoplastic diseases among the hypotheses. In the case in question, the histochemical finding allowed the correct diagnosis of meningeal carcinomatosis, with the central nervous system being an uncommon site for metastatic implantation of squamous cell carcinomas of the upper respiratory tract.

Palavras Chave

SCF; Meningitis; Smoker