Images in Clinical Medicine
Meningeal Carcinomatosis in Breast Cancer
N Engl J Med 2000; 342:1093April 13, 2000
- Article
Figure 1 A 49-year-old woman with progressive metastatic breast cancer despite aggressive chemotherapy was hospitalized with slurred speech, clumsiness of the right hand, and increasing lethargy. Examination revealed that the patient was somnolent but arousable, with dysarthria and dysmetria of the right arm. A cranial magnetic resonance image with gadolinium contrast medium (Panel A) demonstrated leptomeningeal enhancement, which was most prominent over the cerebellum (arrows). Examination of the cerebrospinal fluid revealed an elevated protein concentration (121 mg per deciliter; normal range, 12 to 45), with normal glucose and glutamine concentrations. A Gram's stain was negative for microorganisms. Cytologic analysis (Panel B; Wright's stain, ×500) disclosed abundant clumps of large cells with frequent mitoses (solid arrow) and multinucleated forms (open arrow), characteristic of an aggressive epithelial cancer. The patient's symptoms improved with intravenous hydration and corticosteroids, but she declined further therapy and died at home eight days after discharge.
Deborah L. Ornstein, M.D.
Dartmouth–Hitchcock Medical Center, Lebanon, NH 03756Kirt Frederickson, M.D.
Beth Israel Deaconess Medical Center, Boston, MA 02215- Citing Articles (1)
Citing Articles
1
Theoharis C. Theoharides, Jacek J. Rozniecki, Gary Sahagian, Stanley Jocobson, Duraisamy Kempuraj, Pio Conti, Dimitris Kalogeromitros. (2008) Impact of stress and mast cells on brain metastases. Journal of Neuroimmunology 205:1-2, 1-7
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