Intracranial leptomeningeal carcinomatosis in three cases from breast cancer demonstrated on f-18 fluorodeoxyglucose positron emission tomography/computerized tomography

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Date: January-March 2017
From: Indian Journal of Nuclear Medicine(Vol. 32, Issue 1)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 1,379 words
Lexile Measure: 1480L

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Byline: Hulya. Ortapamuk, Mustafa. Demir

Leptomeningeal carcinomatosis (LC) is an uncommon late manifestation of non-central nervous system (CNS) solid tumors. With prolonged survival in solid tumors, an increased frequency of metastases is noted in these tumors too. The detection of tumor cells in the cerebrospinal fluid remains the gold standard. Noninvasively, magnetic resonance imaging is frequently used for the diagnosis of LC. Although its low sensitivity of F-18 fluorodeoxyglucose positron emission tomography/computerized tomography (F-18 FDG PET/CT) on demonstrating CNS lesions, it could be useful in identifying the possibility of LC of breast carcinoma by giving high attention to the meninges. We discuss here three cases all of them having intracranial LC; where [sup]18F-FDG PET/CT study helped us in the diagnosis of LC. To our knowledge, this is the second report about intracranial LC from breast cancer demonstrating on [sup]18F-FDG PET/CT.

Introduction

Leptomeningeal carcinomatosis (LC) is characterized by invasion of leptomeninges and subarachnoid space by neoplastic cells and frequently with a poor prognosis. Although its treatment is palliative, the earlier diagnosis will lead to prolonged survival and improve functional outcome.[sup][1],[2] It occurs in approximately 2–5% of patients with breast cancer and most of them have intraparenchymal brain metastases concurrent with LC.[sup][3] The most common and definitive method for LC diagnosis is the detection of metastatic cells in cerebrospinal fluid (CSF); the first lumbar puncture reveals positive cytology in only up to 50% of patients, and the yield increases to 90% only after three lumbar punctures. Contrast-enhanced magnetic resonance imaging (MRI) is useful for diagnosis of LC.[sup][1],[4] We present three cases of LC from breast cancer in which [sup]18 F-fluorodeoxyglucose positron emission tomography ([sup]18 F-FDG PET) scan revealed abnormal FDG uptake on intracranial leptomeninges suggesting LC that were confirmed by MRI.

Case Reports

Case 1

A 25-year-old woman with left breast cancer underwent a modified radical mastectomy with axillary dissection followed by six cycles of chemotherapy and local radiotherapy to the chest. She was admitted because of a headache 1 year later. The contrast-enhanced brain MRI was performed, and it revealed that abnormal hyperintense signal and...

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Gale Document Number: GALE|A478631214