Leptomeningeal metastases of a well-differentiated neuroendocrine tumour: a rare entity

J M Versluis; D Brandsma; J G van den Berg; Met Tesselaar

doi:10.1136/bcr-2018-226557

Leptomeningeal metastases of a well-differentiated neuroendocrine tumour: a rare entity

BMJ Case Rep. 2018 Nov 3:2018:bcr2018226557. doi: 10.1136/bcr-2018-226557.

Authors

J M Versluis¹, D Brandsma², J G van den Berg³, Met Tesselaar¹

Affiliations

¹ Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
² Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
³ Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands.

Abstract

A 73-year-old man, without any medical history, had presented with dark urine and pale stool without pain. Diagnostic imaging revealed a tumour in the pancreas with liver metastases. Histopathological examination showed a well-differentiated pancreatic neuroendocrine tumour. After a stable 2.5 years on everolimus, progression of the liver metastases was seen and a switch was made to chemotherapy. Three months later, he developed progressive spinal neurological symptoms. MRI of the spine and brain revealed leptomeningeal contrast-enhancing lesions. Cytopathological examination of the cerebrospinal fluid showed malignant epithelial cells compatible with well-differentiated neuroendocrine tumour. Epithelial cell-adhesion molecule-based flow cytometry of the cerebrospinal fluid confirmed the presence of epithelial tumour cells. Based on these results, the diagnosis of leptomeningeal metastases of an originally well-differentiated neuroendocrine tumour of the pancreas was made.

Keywords: endocrine cancer; neuroendocrinology.

Publication types

Case Reports

MeSH terms

Aged
Cerebrospinal Fluid / cytology
Drug Therapy / methods
Everolimus / administration & dosage
Everolimus / therapeutic use
Fatal Outcome
Humans
Immunosuppressive Agents / therapeutic use
Intestinal Neoplasms / diagnostic imaging
Intestinal Neoplasms / drug therapy
Intestinal Neoplasms / pathology*
Intestinal Neoplasms / secondary
Liver Neoplasms / pathology*
Liver Neoplasms / secondary
Magnetic Resonance Imaging
Male
Meningeal Neoplasms / diagnostic imaging
Meningeal Neoplasms / pathology*
Meningeal Neoplasms / radiotherapy
Meningeal Neoplasms / secondary
Neoplasm Metastasis
Neuroendocrine Tumors / diagnostic imaging
Neuroendocrine Tumors / drug therapy
Neuroendocrine Tumors / pathology*
Neuroendocrine Tumors / secondary
Pancreatic Neoplasms / diagnostic imaging
Pancreatic Neoplasms / drug therapy
Pancreatic Neoplasms / pathology*
Pancreatic Neoplasms / secondary
Stomach Neoplasms / diagnostic imaging
Stomach Neoplasms / drug therapy
Stomach Neoplasms / pathology*
Stomach Neoplasms / secondary

Substances

Immunosuppressive Agents
Everolimus

Supplementary concepts

Gastro-enteropancreatic neuroendocrine tumor