Table 1.
Clinical and instrumental findings in patients with meningeal carcinomatosis (review of literature).
| Study reference | Age and gender | Latency symptoms onset diagnosis | Ocular manifestations | Associated clinical features | Imaging | CSF examination | Original tumor | Treatment | Life expectancy |
|---|---|---|---|---|---|---|---|---|---|
| [4] | 75, M | Not specified | Diplopia, left ptosis, anisocoria | Headache, confusion, hearing loss, VII cn (cranial nerve) palsy | CT scan (normal), MRI (GME) | (1) Prot ↑ (2) not performed |
Bladder and prostate cancer | Declined | 15 days |
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| [5] | 49, F | 10 months | Blurred vision and diplopia, horizontal nystagmus | Dizziness, ataxia, seizures, dysarthria, VII cn palsy, left lower limb weakness | CT scan (normal), MRI + gad (FME, cauda equine, cerebellum) | (1) MTC positive (2) not performed |
Ovarian cancer | WBRT. IT: topotecan (0.4 mg × 4) |
4 months |
|
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| [6] | 39, F | 6 months | Sudden bilateral visual loss, horizontal gaze palsy | headache, vertigo, seizures | MRI + gad (GME) | (1) Prot ↑, glu ↓, MTC + (2) MTC negative |
Gastric adenocarcinoma | RT. IT: MTX (12.5 mg × 2/we) |
— |
|
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| [7] | 40, F | 2 months | Visual loss, bilateral sixth cn palsy, bilat papilledema | Headache, neck pain, meningism | Contrast CT scan (GMEt); MRI + gad (GME) | (1) Prot ↑, glu ↓ (2) negative |
Melanoma | Not done | 1 year (after symptoms onset) |
|
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| [8] | 33, F | 11 months | VI cn palsy | Confusion, seizures, increased intracranial pressure | CT scan (FME, lateral ventricles) | Not performed | Uterine cervical neuroendocrine tumor | RT | 19 months (after cancer diagnosis) |
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| [9] | 58, M | 2 months (symptoms), 12 months (carcinomatosis) |
Left homonymous hemianopia | Headache, ataxia | CT scan and MRI (right infarction of the caudate, internal capsule, and lentiform nucleus) | (1) MTC positive (2) not performed |
Transitional cell carcinoma of the bladder | Not done | — |
|
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| [10] | 54, F | Postmortem diagnosis of the original tumor, 4 months (symptoms-carcinomatosis) | Ptosis, right III cn palsy | V and XII cn palsy, dysgeusia | MRI + gad (GME) | Not performed | Collecting duct carcinoma | IV: mannitol, dexamethasone, and morphinehydrochloride | 3 months |
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| [11] | 65, M | 2 years (carcinomatosis), 6 weeks (symptoms) | Right visual loss | Hearing loss, ataxia | MRI + gad (normal), repeated MRI + gad (FME. bilateral optic nerves, left V cn), bilateral cerebellopontine angle mass | (1) Prot ↑, glu ↓, MCT negative (2) not performed |
Colorectal cancer | RT | — |
|
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| [12] | 61, M | Postmortem diagnosis | III cranial nerve palsy | Flaccid paraparesis with bladder retention, dysarthria, VII cn palsy, right arm weakness | MRI + gad (normal) | (1) Normal (2) Prot ↑, glu ↓, cells ↑ |
Lung adenocarcinoma | Not done | — |
|
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| [13] | 51, F | 15 years (carcinomatosis), 2 months (symptoms) |
Diplopia (VI cn palsy) | Paraparesis with bladder retention, peripheral neuropathy | MRI (normal) | (1) Prot ↑, MTC positive (2) MTC negative |
Breast Cancer |
IT: MTX (15 mg), liposomal Ara-C | Last followup: 3 years and 7 months after carcinomatosis diagnosis (clinically stable) |
|
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| [14] | 67, M | 2 months (symptoms) | Left ptosis, diplopia, and visual loss | Headache, hemifacial sensory loss, paraplegia | MRI (GME, left retrorbital mass) | (1) Cells ↑, MTC negative (2) MTC positive |
Adrenal extranodal NK/T-cell lymphoma | IV: dexamethasone | 2 months (after symptoms onset) |
|
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| [15] | 53, M | 4 months (carcinomatosis) | Intermittent diplopia | Headache, vertigo | CT scan and MRI + gad (normal) | (1) Normal (2) MTC positive |
Gastric cancer | RT(45 Gy), betamethasone (16 mg/die) | 3 months |
|
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| [16] | 43, F | 156 months (carcinomatosis) | Progressive blurred vision and pain in the right eye | — | MRI + gad (FME, right optic nerve ) | (1) MCT positive (2) not performed |
Cervical cancer | RT + triethylenethiophosphoramide | 2 months |
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| [17] | 56, M | 4 days (symptoms) | III cranial nerve palsy | Headache, nausea, and low back pain | MRI + gad (normal) | (1) MTC positive (2) not performed |
Lung cancer | — | — |
|
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| [18] | 31 (average); 3M, 4F |
Average: 8 months (carcinomatosis) | Ptosis (2), diplopia (3), visual loss (3) |
Headache (4), VII cn palsy (1) |
MRI + gad (2 FME, cn, 2 GME, 3 normal) | (1) MTC positive (2) normal |
NHL (3), ALL (1), AML (1), plasmablastic myeloma (1), breast cancer (1) | Ns | Average: 55 days |
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| [19] | 50, F | 2 years (carcinomatosis) | Bilateral loss of vision | Confusion, headache | MRI + gad (thickening intraorbital optic nerves) | (1) Prot ↑, MCT positive (2) not performed |
Ovarian serous cystadenocarcinoma | Ns | Ns |
|
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| [20] | 44, M | 3 months (symptoms carcinomatosis) | Diplopia | Headache, confusion, meningeal signs, facial diplegia, ataxia, deafness | MRI (normal) | (1) Cells ↑, prot ↑, MTC positive (2) MTC negative |
Lung cancer | IT: MTX (10 mg), Ara-C (39 mg). RT | 182 days (after carcinomatosis diagnosis), 272 days (after symptoms onset) |
|
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| [21] | 67, F | 6 months (carcinomatosis) | Blurred vision, diplopia | Headaches, meningeal signs, and SIADH | CT scan (normal) | (1) MTC positive (2) not performed |
Gastric cancer | RT | 7 months (after cancer diagnosis), 2 weeks (after carcinomatosis diagnosis) |
|
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| [22] | 41, M | 2 weeks (symptoms) | Visual loss, left ptosis | Headache, nausea | Contrast CT scan (chiasmal thickening), MRI (hydrocephalus, increased CSF signal in the basal cisterns) | (1) Prot ↑, MTC negative (2) prot ↑, MTC negative |
Rectal carcinoma | Oral: dexamethasone (4 mg) | 5 days (after carcinomatosis diagnosis) |
|
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| [23] | 60, F | 2 weeks (symptoms) | Diplopia, VI cn palsy | Ataxia, VII cn palsy, and hearing loss | CT scan (normal) | (1) Glu ↓, prot ↑, cells ↑, MTC positive (2) MTC negative |
Gallbladder carcinoma | IT: MTX | 2 months and 2 weeks (after symptoms onset) |
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| [24] | — | 5 months (carcinomatosis) | Bilat visual loss papilledema, exotropia, ocular pain | Hemiplegia, SAH | CT scan (normal), MRI (normal) | (1) MTC positive (2) not performed |
Non-Hodgkin lymphoma | IT: MTX, corticosteroids | 2 weeks (after carcinomatosis diagnosis) |
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| [25] | 49, M | Postmortem diagnosis (2 months after symptoms onset) | Visual loss, bilateral blindness | Headache, confusion, leg weakness, dysphagia, seizures, ataxia, and intermittent paralysis | CT scan (normal) | (1) Normal (2) not performed |
Oesophageal adenocarcinoma | Not done | 60 days (after symptoms onset) |
|
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| [26] | 44, M | — | Diplopia | Headache, ataxia, meningeal signs, V, VII, IX, and X cn palsy | — | (1) Cells ↑, MTC positive (2) not performed |
— | IT: Ara-C.RT | — |
|
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| [27] | 35, F | 20 weeks (carcinomatosis), 1 week (symptoms) | Bilat visual loss to blindness | Headache, vomiting, meningeal signs, and loss of consciousness | CT scan (normal) | (1) Prot ↑, glu ↓, cells ↑, MTC positive (2) prot ↑, MTC positive |
Breast cancer | IT: MTX (70 mg tot), Ara-C (80 mg tot) | 21 days (after symptoms onset) |
|
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| [28] | 36, F | NS | Blindness | Headache, loss of consciousness | CT scan (normal) | (1) MTC negative (2) MTC positive |
Lung cancer | IT: MTX, Ara-C, ACNU, IL-2 | 2 years (after carcinomatosis diagnosis) |
|
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| [29] | 60, F | 3 months (symptoms carcinomatosis) | Visual loss | Headaches, paraparesis | CT scan (normal), repeated CT scan of brain and orbits (right globe soft mass) | (1) Prot ↑, cells ↑ (2) prot ↑, cells ↑, MTC positive |
Gastric cancer | Prednisone (80 mg) | — |
|
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| [30] | 37, F | — | Diplopia | Headache, nausea, vomiting, and meningeal signs | — | (1) MTC positive (2) MTC negative |
Gastric cancer | IT: MTX, Ara-C, prednisolone IV: adriamycin, ftorafur |
365 days (after symptoms onset) |
|
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| [31] | 58, M | Postmortem diagnosis | Visual loss | Vertigo, loss of consciousness | — | (1) Cells ↑ (2) not performed |
Colon cancer | Not done | 10 days (after symptoms onset) |
|
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| [32] | 11, M | — | Visual loss | — | — | — | Burkitt's lymphoma | — | — |
|
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| [33] | 49, M | 1 month (symptoms-carcinomatosis) | Scotomas, diplopia | Headache, nausea and vomiting, and vertigo | CT scan (normal) | (1) Prot ↑, cell ↑ (2) MTC positive |
Gastric cancer | IT: MTX 20 mg | 60 days (after symptoms onset) |
|
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| [34] | 59, F | 39 months (carcinomatosis) | Bilateral blindness | Dizziness, tinnitus, and confusion | CT scan (normal) | (1) Prot ↑, MTC positive (2) Pprot ↑, MTC negative. (3) prot ↑, MTC negative. (4) glu ↓, prot ↑, MTC positive. |
Breast cancer | RT. IT: Ara-C (70 mg), dexamethasone. IV: 5-FU, vincristine, MTX. Oral: cyclophosphamide, prednisone | 4 years and 2 months (after cancer diagnosis), 9 months (after carcinomatosis diagnosis) |
| 49, F | 5 years and 3 months (carcinomatosis) | Bilateral blindness | — | CT scan (normal) | (1) Glu ↓, prot ↑, MTC positive (2) normal |
Breast cancer | RT. IT: Ara-C, corticosteroids | 5 years and 6 months (after cancer diagnosis), 3 months (after carcinomatosis diagnosis) | |
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| [35] | 53, F | Postmortem diagnosis (1 month after symptoms onset) |
Anisocoria, papilledema | Headache, hemiparesis, meningeal signs, and loss of consciousness | Subdural hematoma | Not performed | Gastric cancer | — | 26 days (after symptoms onset) |
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| [36] | 53, M | Postmortem diagnosis (3 months after symptoms onset) |
Blindness | Nausea, vomiting, confusion, ataxia, meningeal signs, and seizures | CT scan (normal) | (1) Cells ↑, prot ↑, glu ↓ (2) prot ↑ |
Lung cancer | Not done | 3 months (after symptoms onset) |
|
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| [37] | 59, F | 46 months (symptoms carcinomatosis); 10 months (carcinomatosis) | Scotomas, visual loss to blindness | Cerebellar ataxia | Skull radiography (normal) | (1) cells ↑, MTC positive (2) normal |
Anaplastic endometrioid sarcoma | RT. IT: MTX (20 mg × 4), IM: citrovorum factor |
60 days (after carcinomatosis diagnosis), 365 days (after cancer diagnosis) |
Cn: Cranial nerve; SIADH: syndrome of inappropriate antidiuretic hormone secretion; SAH: subarachnoid Haemorrhage; GME: generalised meningeal enhancement; FME: focal enhancement; NHL: non Hodgkin lymphoma; ALL: acute lymphoblastic leukemia; AML: acute myelocytic leukemia; IT: intrathecal; O: oral; IM: intramuscular.