Development of meningeal carcinomatosis in advanced gastric cancer - - PowerPoint PPT Presentation
ESMO Preceptorship Programme Brain Tumours Athens 28-29/9/2018 Development of meningeal carcinomatosis in advanced gastric cancer Dr. Michele Ghidini Operative Unit of Oncology, Cancer Center, ASST of Cremona, Italy Disclosure slide I
Operative Unit of Oncology, Cancer Center, ASST of Cremona, Italy
Brain Tumours – Athens – 28-29/9/2018
ESMO PRECEPTORSHIP PROGRAMME
ESMO PRECEPTORSHIP PROGRAMME
72 years old, mother affected by gastric cancer;
Non-smoker, no-alcohol consumption, no allergies. Ex-farmer;
Past hydrocele and inguinal hernioplasty.
July 2013: persistent heartburn → gastroscopy with evidence of multiple gastric ulcers. Multiple biopsies performed. Histology: adenocarcinoma;
September 2013: total-body CT scan: no evidence of disease;
26 November 2013: total gastrectomy with histology: gastric adenocarcinoma, grade 2, pT1b pN0 (0/35) R0, early gastric cancer.
Post-surgical development of cholangitis and splenic abscesses treated with ceftriaxone, ampicillin-sulbactam and levofloxacin with final resolution
ESMO PRECEPTORSHIP PROGRAMME
17 November 2016: gastroscopy. Multiple biopsies Histology: high-grade displasia;
January 2017: persistent fever → total-body CT scan: multiple splenic abscesses and diffuse ascites. Gastroscopy: bleeding lesion at the esophagogastroduodenal anastomosis. Histology: adenocarcinoma;
29 March 2017: distal esophagectomy, splenectomy and
(20/31) R0, M+ (splenic metastases).
Post-surgical severe fatigue and nutrition issues. Parenteral nutrition started.
31 May 2017: CT scan: nodal relapse with retroperitoneal nodes (maximum diameter 22 mm). CEA and CA 19.9: negative.
ESMO PRECEPTORSHIP PROGRAMME
Inclusion in clinical phase III first-line trial of maintenance avelumab or continuation of chemotherapy after a 12-weeks induction first-line chemotherapy with oxaliplatin and fluoropyrimidine;
From 28 June to 6 September 2017: 6 cycles of FOLFOX regimen;
14 August 2017: total-body CT scan after 4 cycles: partial response;
14 September 2017: Re-baseline total body CT scan after 6 cycles: stable disease;
27 September 2017: First cycle of avelumab.
ESMO PRECEPTORSHIP PROGRAMME
3 October 2017: onset of severe headache and dizziness. Cranial CT scan: suspected posterior fossa meningioma. Brain MRI execution suggested;
Brain MRI: pathological contrast enhancement in posterior fossa (cerebellum, pons, midbrain) → LEPTOMENINGITIS;
ESMO PRECEPTORSHIP PROGRAMME
ESMO PRECEPTORSHIP PROGRAMME
Lumbar puncture: negative assessments for bacterial or viral
CSF analysis: 49 leucocytes/mm3 (98% mononuclear, 2% polymorphonuclear); glucose 33.4 mg/dL (n.v. 40-70); proteins 132.20 mg/dL (n.v. 15-45); albumin 70.95 mg/dL (n.v. 13-24)
Fast worsening of clinical conditions with onset of coma
DEATH on 10 October 2017