Abstract
BackgroundMeningeal carcinomatosis is a very rare metastatic site of gastric cancer and meningeal carcinomatosis without other metastatic sites is much extremely rare. Herein, we report our experience with a very rare case of meningeal carcinomatosis which was difficult to diagnose the recurrence by general systemic examination and was found due to the deafness despite the sustained high tumor markers.Case presentationA 68-year-old man consulted a hospital with vomiting and hematemesis. Laboratory tests revealed severe anemia. He was referred to our hospital and underwent an emergency gastroscopy, which revealed Borrman type 3 tumor and oozing of blood. Biopsy specimen showed gastric cancer. After several examinations, total gastrectomy was performed and tegafur-gimeracil-oteracil potassium (S-1) was initiated as adjuvant chemotherapy one month after surgery. Tumor marker levels (CEA and CA19-9) remained high for three months after surgery. S-1 was continued while shortening the imaging study follow-up period. Nine months after surgery, he noticed difficulty in hearing with facial paralysis, dizziness, tinnitus, and appetite loss. He was diagnosed with meningeal carcinomatosis and bilateral internal auditory canal metastasis. He died approximately two months later.ConclusionMeningeal carcinomatosis should be considered if bilateral deafness and vestibulopathy develop after gastrectomy, even if no recurrence is apparent in the abdominal cavity.
Highlights
Meningeal carcinomatosis is a very rare metastatic site of gastric cancer and meningeal carcinomatosis without other metastatic sites is much extremely rare
Meningeal carcinomatosis should be considered if bilateral deafness and vestibulopathy develop after gastrectomy, even if no recurrence is apparent in the abdominal cavity
We report a rare and suggestive clinical case presenting sudden deafness and facial paralysis with a rapid progress due to metastatic recurrences from gastric cancer
Summary
It was difficult to detect the recurrence of our patient by general systemic examination despite the sustained high tumor markers and work up could not detect any metastatic site such as the liver and lung. Both CT and enhanced MRI should be performed to check the intracranial metastatic target in cases where the tumor marker levels remain high. If meningeal carcinomatosis is suspected, CSF test should be performed rapidly. If the diagnosis can be made quickly, the patient’s symptom and distress might be alleviated, even though the prognosis is poor
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