Neoplastic meningitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Neoplastic meningitis is the development of meningitis due to infiltration of the subarachnoid space by tumor cells. Malignant cells come from primary cancer such as breast cancer or from a primary brain tumor like medulloblastoma.[1] The microscopic pathology of neoplastic meningitis may vary according to the primary cancer involved. Generally, on microscopic histopathological analysis, neoplastic meningitis is characterized by large, hyperchromatic cells.
Historical Perspective
Neoplastic meningitis was first reported in the 1870's.[1]
Classification
There is no classification system established for neoplastic meningitis.
Pathophysiology
Neoplastic meningitis refers to the spread of malignant cells through the cerebrospinal fluid space. These cells can be originated both in primary CNS tumors (e.g. drop-metastases), as well as from distant tumors that have metastasized (hematogenous spread).[2] The microscopic pathology of neoplastic meningitis may vary according to the primary cancer involved. Generally, on microscopic histopathological analysis, neoplastic meningitis is characterized by large, hyperchromatic cells.[3]
Causes
Common causes of neoplastic meningitis include primary intracerebral malignancies (glioblastoma multiforme, anaplastic astrocytoma, medulloblastoma) and metastatic disease (breast cancer, lung cancer, melanoma, lymphoma, leukemia).[4]
Differentiating Neoplastic Meningitis from other Diseases
Neoplastic meningitis must be differentiated from infections (meningitis, Lyme disease, neurocysticercosis), neoplastic (intracerebral metastasis, dural metastasis), inflammatory (rheumatoid arthritis, multiple sclerosis, polychondritis), and granulomatous disorders (sarcoidosis, histiocytosis, Wegener's granulomatosis, vasculitis).[5]
Epidemiology and Demographics
Neoplastic meningitis occurs in approximately 3-5% of patients with solid tumor, 5-15% of patients with leukemia, and 1-2% of patients with primary brain tumors.[6][7]
Risk Factors
There are no established risk factors for neoplastic meningitis.
Screening
There is insufficient evidence to recommend routine screening for neoplastic meningitis.[8]
Natural History, Complications and Prognosis
Neoplastic meningitis has a widely disseminated and progressive presentation. If left untreated, neoplastic meningitis may progress to develop seizures, hydrocephalus, encephalopathy, and ultimately death.[9] Complications of neoplastic meningitis include hydrocephalus, encephalopathy, empyema, cerebritis, cerebral abscess, and stroke.[9] The median survival time of patients without treatment of neoplastic meningitis is 4-6 weeks.[10]
Diagnosis
Staging
There is no established system for the staging of choroid plexus papilloma.[11]
History and Symptoms
When evaluating a patient for neoplastic meningitis, you should take a detailed history of the presenting symptom (onset, duration, and progression), other associated symptoms, and a thorough family and past medical history review. Other specific areas of focus when obtaining the history include review of common associated conditions such as intracerebral metastases and the distant primary tumors. Neoplastic meningitis should be suspected if there are simultaneous occurrence of symptoms or signs in more than one area of the neuraxis.[12] Symptoms of neoplastic meningitis include headaches, confusion, memory loss, seizures, double vision, hearing loss, paresthesia and pain in the neck and back, and limb weakness.[13]
Physical Examination
Common physical examination findings of neoplastic meningitis include altered mental status, dementia, hemiparesis, ptosis, nuchal rigidity, bowel and bladder dysfunction, and papilledema.[13]
Laboratory Findings
Laboratory findings consistent with the diagnosis of neoplastic meningitis include abnormal CSF analysis (increased opening pressure, increased leukocytes, elevated protein, decreased glucose, and positive tumor markers). Only 50% of those suspected with neoplastic meningitis are actually diagnosed and only the presence of malignant cells in the CSF is diagnostic.[14]
CT
There are no CT scan findings associated with neoplastic meningitis.[13]
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
There are no primary or secondary preventive measures available for neoplastic meningitis.
References
- ↑ 1.0 1.1 Neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 19, 2016
- ↑ Leptomeningeal metastases. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/leptomeningeal-metastases. Accessed on January 20, 2016
- ↑ Berzero, Giulia; Diamanti, Luca; Di Stefano, Anna Luisa; Bini, Paola; Franciotta, Diego; Imarisio, Ilaria; Pedrazzoli, Paolo; Magrassi, Lorenzo; Morbini, Patrizia; Farina, Lisa Maria; Bastianello, Stefano; Ceroni, Mauro; Marchioni, Enrico (2015). "Meningeal Melanomatosis: A Challenge for Timely Diagnosis". BioMed Research International. 2015: 1–6. doi:10.1155/2015/948497. ISSN 2314-6133.
- ↑ Pathology of leptomeningeal metastases. Dr Bruno Di Muzio and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/leptomeningeal-metastases. Accessed on January 19, 2016
- ↑ Leptomeningitis. Dr Amir Rezaee and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/leptomeningitis. Accessed on January 21, 2016
- ↑ Gleissner, Beate; Chamberlain, Marc Charles (2006). "Neoplastic meningitis". The Lancet Neurology. 5 (5): 443–452. doi:10.1016/S1474-4422(06)70443-4. ISSN 1474-4422.
- ↑ Hayat, M. A. Brain metastases from primary tumors : epidemiology, biology, and therapy. London: Elsevier/Academic Press, 2014. Print.| url=https://books.google.com/books?id=IloXAwAAQBAJ&pg=PA43&lpg=PA43&dq=leptomeningeal+carcinomatosis+is+present+in+1-5%25+of+patients+with+solid+tumors,+5-15%25+of+patients+with+leukemia,+and+1-2%25+of+patients+with+primary+brain+tumors.&source=bl&ots=ehEaDBCT5f&sig=vvSxdxDjNMBe0CdCP6fEcMaYJqU&hl=en&sa=X&ved=0ahUKEwi2ueuw37bKAhUG8j4KHWUUCoIQ6AEILTAC#v=onepage&q=leptomeningeal%20carcinomatosis%20is%20present%20in%201-5%25%20of%20patients%20with%20solid%20tumors%2C%205-15%25%20of%20patients%20with%20leukemia%2C%20and%201-2%25%20of%20patients%20with%20primary%20brain%20tumors.&f=false. Accessed on January 19, 2016
- ↑ Early detection, diagnosis, and staging of brain tumors. American cancer society. http://www.cancer.org/cancer/braincnstumorsinadults/detailedguide/brain-and-spinal-cord-tumors-in-adults-detection
- ↑ 9.0 9.1 Complications of leptomeningitis. Dr Amir Rezaee and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/leptomeningitis. Accessed on January 21, 2016
- ↑ Prognosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016
- ↑ Chandana SR, Movva S, Arora M, Singh T (2008). "Primary brain tumors in adults". Am Fam Physician. 77 (10): 1423–30. PMID 18533376.
- ↑ "Infiltration of the Leptomeninges by Systemic Cancer-A Clinical and Pathologic Study". doi:10.1001/archneur.1974.00490320010002. Check
|doi=value (help). - ↑ 13.0 13.1 13.2 Chamberlain, M. C. (2008). "Neoplastic Meningitis". The Oncologist. 13 (9): 967–977. doi:10.1634/theoncologist.2008-0138. ISSN 1083-7159.
- ↑ Diagnosis of neoplastic meningitis. Wikipedia 2016. https://en.wikipedia.org/wiki/Neoplastic_meningitis. Accessed on January 20, 2016