A meningeal carcinomatosis occurring 8 months after radical surgery with neoadjuvant chemotherapy for peritoneal dissemination of gastric cancer

Abstract

A 71-year-old man underwent staging laparoscopy for HER2-positive advanced gastric cancer; staging laparoscopy revealed peritoneal dissemination. He received neoadjuvant chemotherapy including trastuzumab (T-mab). After the chemotherapy, he underwent staging laparoscopy again. Peritoneal dissemination was not found, and he underwent total gastrectomy (D2) and splenectomy. Pathological diagnosis was poorly differentiated adenocarcinoma invading the submucosa. Harvested lymph nodes were all free of metastasis. Peritoneal dissemination and peritoneal cytology was negative. After curative resection, combination therapy of S-1 and T-mab was administered. At 8 months after the gastric cancer surgery, nausea appeared. Serum CEA concentration was elevated. Recurrent signs were not found on chest and abdominal enhanced CT. He was urgently hospitalized for decreased level of consciousness. Enhanced MRI revealed abnormal enhancement effects of the pia mater of the cerebellum, midbrain and right temporal lobe. Because there were not infection signs, infectious meningitis was denied. Meningeal carcinomatosis was diagnosed from progress, and he died 12 days after being diagnosed. Meningeal carcinomatosis is a rare complication of gastric cancer, and its prognosis is poor. There are a wide variety of symptoms in meningeal carcinomatosis. In some cases, a definitive diagnosis is very difficult. We considered it important to report our experience to emphasize the need to include meningeal carcinomatosis in the differential diagnoses for patients presenting with cerebral and cranial signs.