Abstract Details

Title Rapid Fulminant Carcinomatous Meningitis Despite Complete Eradication of Squamous Cell Carcinoma of the Pharynx

Topic Neuro-oncology

Presentation(s) P01 - (-)

Poster/Presentation
Number 112

Objective

Background The involvement of the leptomeninges by metastatic tumors occurs as a late event due to fulminant disseminated spread of systemic disease. Here we report a case of meningeal carcinomatosis months after complete eradication of primary tumor.

Design/Methods Longitudinal case report.

Results Our patient is a 64 year-old male with a history of left pharyngeal wall squamous carcinoma which was surgically resected. Six years later he presented with left Bells palsy and left parapharyngeal mass. Reimaging and needle biopsy confirmed the reappearance of primary tumor, which was treated aggressively with chemotherapy and radiation. PET scan confirmed eradication. He presented six months later with two month history of progressive gait imbalance and weight loss. Exam showed inability of tandem gait and the old Bells palsy. Brain MRI was unremarkable. When admitted to Albany VA four months later, exam showed sensory loss and dysmetria of the lower extremities. Brain imaging showed hydrocephalus, cerebellar and frontal lobe atrophy, but the primary tumor was absent. Cerebrospinal fluid analysis showed absence of malignant cells. The patient's condition declined precipitously nine days later. Imaging showed worsening hydrocephalus. He died soon after and autopsy revealed leptomeningeal involvement of his squamous cell carcinoma.

Conclusions Tumor cells can gain access to the meningeal spaces via direct spread, hematogenous spread, or retrograde invasion along the cranial and spinal nerves. Alarmingly, our patient had a very slow pace of the disease with mild neurological deficits and imaging findings, but had a precipitous and fatal decline. We think he most likely had perineural spread along the left facial nerve years prior to this presentation. To our knowledge this is the only case of fulminant leptomeningeal reemergence of squamous carcinoma despite negative imaging results. Practitioners should be aware of this possibility in patients presenting with worsening hydrocephalus with a past history of solid pharyngeal tumors.

Authors/Disclosures
Chrystal M. Reed, MD, PhD (Cedars Sinai Medical Center) PRESENTER	Dr. Reed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint.
Tjalf Ziemssen, MD, FAAN (University Clinic Dresden)	Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS . Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Roche. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for TEVA. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Dresden Internation University. The institution of Dr. Ziemssen has received research support from Novartis. The institution of Dr. Ziemssen has received research support from Merck. The institution of Dr. Ziemssen has received research support from Sanofi. The institution of Dr. Ziemssen has received research support from BMS. The institution of Dr. Ziemssen has received research support from Roche.
Richard Tomasulo, MD (University of Virginia)	No disclosure on file
JS Charleston	No disclosure on file

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