-Case Reports-

A Case of Meningeal Carcinomatosis with Gastric Cancer Which Manifested Meningeal Signs as the Initial Symptom; the Palliative Benefit of Radiotherapy

Takeshi Yamada^1,2, Kiyonori Furukawa^1,2, Kimiyoshi Yokoi^1,2, Yoshiharu Ohaki³, Susumu Okada⁴ and Takashi Tajiri¹

¹Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
²Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
³Department of Pathology, Nippon Medical School Chiba Hokusoh Hospital
⁴Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital

A 53-year-old male presenting with anorexia, intermittent diplopia, general fatigue, headache and vertigo was admitted to our hospital. He was diagnosed as having gastric cancer by endoscopy of his upper gastrointestinal tract. Brain computed tomography (CT) showed no abnormalities, but magnetic resonance imaging (MRI) showed slight enhancement in the cerebellar sulcus. Cytological examination of cerebrospinal fluid revealed malignant cells. He became blind one week after hospitalization. We diagnosed his condition as meningeal carcinomatosis (MC) and started radiotherapy. His vision improved after four weeks of treatment, and then he became totally blind again. Since his general condition remained poor, we did not perform chemotherapy. He died on the 127^th day of hospitalization. MC is a rare pathosis of gastric cancer in comparison with leukemia and malignant lymphoma. This disease does not often show characteristic pictorial images, and early diagnosis is difficult. Moreover, it usually manifests itself in its late stages after several months or more of treatment, and it is rare for MC to be present at the time of initial diagnosis. We present a case of gastric cancer with meningeal signs present when the primary tumors were diagnosed. Radiotherapy alleviated some of the symptoms, and the patient survived for as long as patients undergoing enforced chemotherapy.

J Nippon Med Sch 2008; 75: 216-220

Keywords
meningeal carcinomatosis, gastric cancer, MRI

Correspondence to
Takeshi Yamada, Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inba-mura, Inba-gun, Chiba 270-1694, Japan
y-tak@nms.ac.jp

Received, February 27, 2008
Accepted, March 31, 2008