A case of lung adenocarcinoma with bilateral progressive sensorineural hearing loss due to meningeal carcinomatosis

Abstract

Background. Meningeal carcinomatosis caused by dissemination of malignant tumor cells to the meninges is a disease with a poor prognosis and presents with varied neurological symptoms. Case. A 65-year-old Japanese man underwent chemoradiotherapy for treatment of cT2aN3M0 stage IIIB lung adenocarcinoma. He thereafter developed lymph node metastasis labeled relapse and received subsequent chemotherapies. During the course of the treatment, he experienced right-side hearing loss, and his audiogram demonstrated sensorineural hearing impairment of his both ears. Contrast-enhanced brain magnetic resonance imaging (MRI) indicated the possible development of right acoustic neuroma. Five months later, MRI also revealed the emergence of a tumor on the left acoustic nerve. Gradual growth of both acoustic tumors was noted on follow-up MRI. Despite the continuation of chemotherapies against lung cancer, 12 months after the onset of right-side hearing loss, his bilateral auditory ability had deteriorated severely, and left facial paralysis also appeared. A cerebrospinal fluid examination suggested carcinomatous meningitis. He eventually died of lymphangitis carcinomatosis after another three months. A pathological autopsy revealed that adenocarcinoma cells had infiltrated the bilateral acoustic nerve. We therefore diagnosed him with meningeal carcinomatosis, in which adenocarcinoma cells had disseminated to the bilateral internal auditory canal. Conclusion. When the symptom of hearing loss develops during therapy in patients with advanced lung cancer, it is necessary to consider the possibility of meningeal carcinomatosis.