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Leptomeningeal Carcinomatosis:  Cerebrospinal Fluid Findings

Mario Habek, MD; Damir Petravić, MD, PhD; Koraljka Gjadrov-Kuveždić, MD, MS; Daria Mahović Lakušić, MD
Arch Neurol. 2006;63(6):910. doi:10.1001/archneur.63.6.910.
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A 62-year-old man with microcellular lung cancer (T3N1M1, stage IV) diagnosed 5 months prior sought care for sudden right-sided limb weakness and speech disturbance. Neurologic examination revealed hemiparesis of the right limbs and motor dysphasia. In the next few days, he developed left external ophthalmoplegia with left peripheral facial palsy, left unilateral paralysis of the soft palate, and cognitive impairment, including lethargy and confusion. The findings from contrast-enhanced brain computed tomographic scans performed on 2 occasions were normal. Cerebrospinal fluid examination revealed 92 cells, 81 of which were poorly differentiated malignant cells (Figure 1 and Figure 2), a low glucose level of 2.10 mmol/L (37.8 mg/dL), protein level of 1.69 g/L, and elevated lactate dehydrogenase levels (301 U/L). Magnetic resonance imaging was not performed because the patient died as a result of complications (sepsis and pneumonia).

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Figure 1.

Metastatic malignant cells in cerebrospinal fluid. Several well-preserved malignant cells, with an increased nuclear–cytoplasmatic area ratio, shape irregularities in the nuclear membrane, and hyperchromatic nuclei can be seen. Malignant naked nuclei are also visible (May-Grünwald Giemsa, original magnification × 100).

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Figure 2.

Metastatic malignant cells in cerebrospinal fluid. Cellular phagocytosis (cannibalism), a rare but distinct entity where a malignant cell appears to be contained in a vacuole of the cytoplasm of another malignant cell can be seen (May-Grünwald Giemsa, original magnification × 100).

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