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Leptomeningeal metastasis from hepatocellular carcinoma with other unusual metastases: a case report.

Pan Z, Yang G, Yuan T, Pang X, Wang Y, Qu L, Dong L - BMC Cancer (2014)

Bottom Line: The primary tumor in adults is most often breast cancer, lung cancer, or melanoma.The neurological symptoms of the patient were relieved after treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy.Treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy was effective.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiotherapy, Norman Bethune First Hospital, Jilin University, 71 Xinmin Street, Changchun 130021, China. drlhdong@163.com.

ABSTRACT

Background: Leptomeningeal metastasis, which results from metastasis of tumors to the arachnoid and pia mater, can lead to the dissemination of tumor cells throughout the subarachnoid space via the cerebral spinal fluid, and frequently with a poor prognosis. The primary tumor in adults is most often breast cancer, lung cancer, or melanoma. Although leptomeningeal metastasis due to cholangiocarcinoma has been reported, to the best of our knowledge there is no cytologically confirmed report of leptomeningeal metastasis from hepatocellular carcinoma.

Case presentation: We herein report a case of leptomeningeal metastasis from hepatocellular carcinoma in a 53-year-old woman with concomitant systemic metastases to the lung, bone, brain, kidney, adrenal gland, subcutaneous tissues, and abdominal pelvis. The neurological symptoms of the patient were relieved after treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy.

Conclusion: To our knowledge this is the first report of leptomeningeal metastasis from hepatocellular carcinoma confirmed by cytology. Treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy was effective.

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Abdominal CT. A-D) Plain scanning and triphasic contrast-enhanced scanning of lesions in the left liver lobe. E) Adrenal gland and kidney lesions. F) Lesions in the subcutaneous fat layer.
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Figure 1: Abdominal CT. A-D) Plain scanning and triphasic contrast-enhanced scanning of lesions in the left liver lobe. E) Adrenal gland and kidney lesions. F) Lesions in the subcutaneous fat layer.

Mentions: On examination, painless subcutaneous nodules were found scattered throughout her body. Routine tests for hepatic and renal function, and blood and coagulation were normal, and hepatitis B, hepatitis C, syphilis, and human immunodeficiency virus tests were all negative. Tumor marker levels were: CA 125, 1438.0 U/mL; CA 153, 93.63 U/mL; CA 72–4, 300.0 U/mL; NSE, 13.4 ng/mL; CYFRA 21–1, 8.4 ng/mL; CA 199, 176.1 U/mL; AFP, 1.95 ng/mL; and CEA, 155.0 ng/mL.Computed tomography (CT) of the abdomen showed multiple lesions in the left lobe of the liver (Figure 1A-D), bilateral adrenal gland and kidney lesions (Figure 1E), multiple nodular lesions in the abdominal cavity (Figure 1E), and multiple nodules in the subcutaneous fat layer (Figure 1F). The chest CT scan showed lesions in the inferior lobe of the right lung and multiple subcutaneous nodular shadows (Figure 2A). The pelvic CT scan showed pelvic nodules and multiple subcutaneous nodular shadows (Figure 2B). The bone scan revealed increased radioactivity in the right femur (Figure 2C). The patient felt a headache on the third day of admission and the head magnetic resonance image showed multiple lesions in the brain and lesions in the right side of the cerebellopontine angle (Figure 2D).A subcutaneous tumor in the right shoulder was cut as biopsied, and the pathological examination showed metastatic cancer invasion (Figure 3A). Immunohistochemical analysis was positive for KI-67 (60%), CK20 (interspersed), CK, villin (focal), Hep Par-1, mammaglobin, CDX2, and TTF1; and negative for vimentin, GPC3, GCDFP-15, CK5/6, and napsin A. This confirmed the histological diagnosis of HCC. Histopathological examination of liver biopsy lesions revealed HCC (middle differentiation; Figure 3B). Immunohistochemical analysis was positive for CK7, CK20 (weak), CK18, CDX2 (weak), Hep Par-1, TTF1; and negative for GPC3, AFP, and napsin A. Hence, a diagnosis was made of HCC with metastases to the lung, bone, brain, kidney, adrenal gland, subcutaneous tissues, and abdominal pelvis. The Child-Pugh grade was A and the Karnofsky performance status score was 80 points.


Leptomeningeal metastasis from hepatocellular carcinoma with other unusual metastases: a case report.

Pan Z, Yang G, Yuan T, Pang X, Wang Y, Qu L, Dong L - BMC Cancer (2014)

Abdominal CT. A-D) Plain scanning and triphasic contrast-enhanced scanning of lesions in the left liver lobe. E) Adrenal gland and kidney lesions. F) Lesions in the subcutaneous fat layer.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4048255&req=5

Figure 1: Abdominal CT. A-D) Plain scanning and triphasic contrast-enhanced scanning of lesions in the left liver lobe. E) Adrenal gland and kidney lesions. F) Lesions in the subcutaneous fat layer.
Mentions: On examination, painless subcutaneous nodules were found scattered throughout her body. Routine tests for hepatic and renal function, and blood and coagulation were normal, and hepatitis B, hepatitis C, syphilis, and human immunodeficiency virus tests were all negative. Tumor marker levels were: CA 125, 1438.0 U/mL; CA 153, 93.63 U/mL; CA 72–4, 300.0 U/mL; NSE, 13.4 ng/mL; CYFRA 21–1, 8.4 ng/mL; CA 199, 176.1 U/mL; AFP, 1.95 ng/mL; and CEA, 155.0 ng/mL.Computed tomography (CT) of the abdomen showed multiple lesions in the left lobe of the liver (Figure 1A-D), bilateral adrenal gland and kidney lesions (Figure 1E), multiple nodular lesions in the abdominal cavity (Figure 1E), and multiple nodules in the subcutaneous fat layer (Figure 1F). The chest CT scan showed lesions in the inferior lobe of the right lung and multiple subcutaneous nodular shadows (Figure 2A). The pelvic CT scan showed pelvic nodules and multiple subcutaneous nodular shadows (Figure 2B). The bone scan revealed increased radioactivity in the right femur (Figure 2C). The patient felt a headache on the third day of admission and the head magnetic resonance image showed multiple lesions in the brain and lesions in the right side of the cerebellopontine angle (Figure 2D).A subcutaneous tumor in the right shoulder was cut as biopsied, and the pathological examination showed metastatic cancer invasion (Figure 3A). Immunohistochemical analysis was positive for KI-67 (60%), CK20 (interspersed), CK, villin (focal), Hep Par-1, mammaglobin, CDX2, and TTF1; and negative for vimentin, GPC3, GCDFP-15, CK5/6, and napsin A. This confirmed the histological diagnosis of HCC. Histopathological examination of liver biopsy lesions revealed HCC (middle differentiation; Figure 3B). Immunohistochemical analysis was positive for CK7, CK20 (weak), CK18, CDX2 (weak), Hep Par-1, TTF1; and negative for GPC3, AFP, and napsin A. Hence, a diagnosis was made of HCC with metastases to the lung, bone, brain, kidney, adrenal gland, subcutaneous tissues, and abdominal pelvis. The Child-Pugh grade was A and the Karnofsky performance status score was 80 points.

Bottom Line: The primary tumor in adults is most often breast cancer, lung cancer, or melanoma.The neurological symptoms of the patient were relieved after treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy.Treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy was effective.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiotherapy, Norman Bethune First Hospital, Jilin University, 71 Xinmin Street, Changchun 130021, China. drlhdong@163.com.

ABSTRACT

Background: Leptomeningeal metastasis, which results from metastasis of tumors to the arachnoid and pia mater, can lead to the dissemination of tumor cells throughout the subarachnoid space via the cerebral spinal fluid, and frequently with a poor prognosis. The primary tumor in adults is most often breast cancer, lung cancer, or melanoma. Although leptomeningeal metastasis due to cholangiocarcinoma has been reported, to the best of our knowledge there is no cytologically confirmed report of leptomeningeal metastasis from hepatocellular carcinoma.

Case presentation: We herein report a case of leptomeningeal metastasis from hepatocellular carcinoma in a 53-year-old woman with concomitant systemic metastases to the lung, bone, brain, kidney, adrenal gland, subcutaneous tissues, and abdominal pelvis. The neurological symptoms of the patient were relieved after treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy.

Conclusion: To our knowledge this is the first report of leptomeningeal metastasis from hepatocellular carcinoma confirmed by cytology. Treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy was effective.

Show MeSH
Related in: MedlinePlus