Neoplastic meningitis due to colorectal cancer
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CASE REPORT
Neoplastic meningitis due to colorectal cancer Kaoru Kidate1 · Hironori Kobayashi1 · Katsunari Miyamoto1 · Yoshihiro Sakashita1 · Motoki Ninomiya1 · Yujiro Yokoyama1 · Yasushi Hashimoto1 · Kazuhiro Toyota1 · Fumio Shimamoto2 Received: 6 November 2019 / Accepted: 9 June 2020 © Japanese Society of Gastroenterology 2020
Abstract Herein, we describe a rare case of neoplastic meningitis in a 54-year-old male with a history of colorectal cancer. He first noticed a loss of sensation in his left thigh along with back pain. Magnetic resonance imaging showed a tumor lesion in the cauda equina. The tumor was surgically resected and pathologically diagnosed as a metastatic tumor of the descending colon cancer for which he had undergone resection a year earlier. The patient was treated with chemotherapy using capecitabine, oxaliplatin, and cetuximab. During chemotherapy, his tumor markers decreased and magnetic resonance imaging showed tumor shrinkage, but he became aware of neurological symptoms such as hearing loss, tinnitus, and headache. The patient’s condition suddenly worsened during the 5th course of chemotherapy and he died 5 months after the diagnosis. Neoplastic meningitis occurs in 4–15% of patients with solid tumors, but it is rarely seen in colorectal cancer. It should be considered when a patient with a history of cancer has back pain or neurological symptoms. The progression of neoplastic meningitis is fast and it has a poor prognosis. Diagnosis in the early stages is important to prevent progression of neurological symptoms and to provide the most effective treatment. Keywords Neoplastic meningitis · Colorectal cancer · Serrated polyposis syndrome
Introduction Neoplastic meningitis is a condition caused by the spread of malignant cells to the leptomeninges and subarachnoid space, disseminating within the cerebrospinal fluid [1]. It is reportedly seen in 4–15% of all patients with solid tumors, being common in those with adenocarcinoma of the breast or lung and melanoma [2], but rare in those with colon cancer [3]. The symptoms of neoplastic meningitis are not specific. It mainly presents with neurological symptoms, such as headache, mental changes, sensory loss, and hearing loss [1, 4, 5]. Our patient first noticed back pain and sensory loss of this left thigh and gradually developed other neurological symptoms. The progression of neoplastic meningitis is rapid
* Kaoru Kidate [email protected] 1
Department of Surgery, Hiroshima Memorial Hospital, 1‑4‑3 Honkawa cho, Naka‑ku, Hiroshima, Hiroshima 730‑0802, Japan
Department of Health Nutrition, Hiroshima Shudo University, 1‑1‑1, Ozuka‑higashi, Asaminami‑Ku, Hiroshima 731‑3195, Japan
2
and chemotherapy can only slow down the speed of progression [2]. There is no standard treatment for this disease and the prognosis is poor [2, 3]. Diagnosis in the early stages is important to prevent important neurological deficits and to provide the most appropriate treatment. Here, we report a rare case of neoplastic meningitis located in the caud
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