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1. Clarke JL, Perez HR, Jacks LM, Panageas KS, Deangelis LM: Leptomeningeal metastases in the MRI era. Neurology; 2010 May 4;74(18):1449-54
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Leptomeningeal metastases in the MRI era.
  • BACKGROUND: Diagnosis of leptomeningeal metastasis (LM) has become increasingly frequent.
  • Diagnosis was made by malignant cytology or imaging; suspicious cases treated as LM were also included.
  • The most common types of solid tumor were breast (65 patients), lung (47), gastrointestinal (11), and melanoma (9).
  • Treatment included radiation therapy in 55%, intrathecal chemotherapy in 29%, and systemic chemotherapy in 18%; 21% received supportive care alone.
  • In multivariate analysis, initial KPS and tumor type (solid vs hematopoietic) were significant predictors of survival.
  • CONCLUSIONS: Despite enhanced diagnosis with MRI, prognosis remains poor in leptomeningeal metastasis.

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  • [CommentIn] Neurology. 2011 Jan 11;76(2):200; author reply 200-1 [21220726.001]
  • (PMID = 20439847.001).
  • [ISSN] 1526-632X
  • [Journal-full-title] Neurology
  • [ISO-abbreviation] Neurology
  • [Language] ENG
  • [Grant] United States / NCI NIH HHS / CA / UO1 CA-105663-01
  • [Publication-type] Journal Article; Research Support, N.I.H., Extramural
  • [Publication-country] United States
  • [Other-IDs] NLM/ PMC2871005
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2. Hukin J, Siffert J, Velasquez L, Zagzag D, Allen J: Leptomeningeal dissemination in children with progressive low-grade neuroepithelial tumors. Neuro Oncol; 2002 10;4(4):253-60
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  • [Title] Leptomeningeal dissemination in children with progressive low-grade neuroepithelial tumors.
  • Our purpose is to describe the incidence and clinical features of leptomeningeal dissemination (LM) in children with progressive low-grade neuroepithelial tumor (LGN).
  • Satisfactorily followed data were obtained on 427 of the 588 patients with localized LGN at diagnosis between 1986 and 1998, 177 (42%) of whom developed progressive or recurrent disease.
  • The primary tumor sites were diencephalon (6), brainstem (3), cerebellum (2), cerebrum (1), and spinal cord (1).
  • Management included chemotherapy (2) or radiotherapy (3) or both (7); 1 patient received only radical resections of symptomatic lesions.
  • We strongly urge that for optimum treatment planning all patients with recurrent LGN be staged with an enhanced spine and brain MRI before adjuvant therapy is initiated.
  • The good survival of patients with LGN and LM reflects a more indolent disease than malignant CNS tumors with LM.
  • [MeSH-minor] Adolescent. Adult. Child. Child, Preschool. Combined Modality Therapy. Disease Progression. Female. Humans. Infant. Magnetic Resonance Imaging. Male. Neoplasm Recurrence, Local / epidemiology. Neoplasm Recurrence, Local / therapy. Survival Analysis. Treatment Outcome

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  • (PMID = 12356355.001).
  • [ISSN] 1522-8517
  • [Journal-full-title] Neuro-oncology
  • [ISO-abbreviation] Neuro-oncology
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Other-IDs] NLM/ PMC1920666
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3. Shinno K, Nagahiro S, Uno M, Kannuki S, Nakaiso M, Sano N, Horiguchi H: Neurocutaneous melanosis associated with malignant leptomeningeal melanoma in an adult: clinical significance of 5-S-cysteinyldopa in the cerebrospinal fluid---case report. Neurol Med Chir (Tokyo); 2003 Dec;43(12):619-25
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  • [Title] Neurocutaneous melanosis associated with malignant leptomeningeal melanoma in an adult: clinical significance of 5-S-cysteinyldopa in the cerebrospinal fluid---case report.
  • A 35-year-old male presented with a variant of neurocutaneous melanosis with leptomeningeal malignant melanoma.
  • Ventriculoperitoneal shunting was performed and extensive pigmented leptomeninges were recognized.
  • Open biopsy established the diagnosis of leptomeningeal malignant melanoma.
  • The 5-S-CD level decreased after each treatment, but the basal level steadily increased prior to the next treatment.
  • Two years after the onset, he showed paraplegia caused by an extramedullary mass at the T-6 level.
  • He underwent emergent removal of the spinal tumor and showed transient marked improvement.
  • Further intensive chemotherapy was given.
  • However, he died 31 months after the onset of massive proliferation of intracranial leptomeningeal melanoma.
  • Measurement of CSF 5-S-CD levels is valuable for evaluating the therapeutic efficacy and for monitoring the progression of melanoma.

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  • (PMID = 14723271.001).
  • [ISSN] 0470-8105
  • [Journal-full-title] Neurologia medico-chirurgica
  • [ISO-abbreviation] Neurol. Med. Chir. (Tokyo)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 19641-92-0 / Cysteinyldopa
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4. Yang WQ, Senger D, Muzik H, Shi ZQ, Johnson D, Brasher PM, Rewcastle NB, Hamilton M, Rutka J, Wolff J, Wetmore C, Curran T, Lee PW, Forsyth PA: Reovirus prolongs survival and reduces the frequency of spinal and leptomeningeal metastases from medulloblastoma. Cancer Res; 2003 Jun 15;63(12):3162-72
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  • [Title] Reovirus prolongs survival and reduces the frequency of spinal and leptomeningeal metastases from medulloblastoma.
  • Medulloblastoma (MB), the most common pediatric brain tumor, is a highly malignant disease with a 5-year survival rate of only 60%.
  • Tumor cells invade surrounding tissue and disseminate through cerebral spinal fluid, making treatment difficult.
  • Human reovirus type 3 exploits an activated Ras pathway in tumor cells to support productive infection as an oncolytic virus.
  • Here, we examined the ability of human reovirus to kill MB cells lines and surgical specimens in vitro and inhibit tumor growth/metastases in vivo.
  • Repeating this experiment with GFP-labeled Daoy cells and multiple i.t. administrations of reovirus, we again found prolonged survival and a dramatic reduction in spinal and leptomeningeal metastases (66.7% in control injections versus 0.0% in the live virus group).
  • These data suggest that this oncolytic virus may be a potentially effective novel therapy against human MB.
  • [MeSH-major] Biological Therapy. Cerebellar Neoplasms / therapy. Mammalian orthoreovirus 3 / physiology. Medulloblastoma / secondary. Meningeal Neoplasms / secondary. Spinal Cord Neoplasms / secondary
  • [MeSH-minor] Animals. Drug Administration Schedule. Enzyme Activation. Eukaryotic Initiation Factor-2 / antagonists & inhibitors. Female. Genes, Reporter. Genes, p53. Green Fluorescent Proteins. Humans. Injections, Spinal. Luminescent Proteins / analysis. Luminescent Proteins / genetics. Mice. Mice, Nude. Neoplasm Proteins / physiology. Proto-Oncogene Proteins p21(ras) / physiology. Signal Transduction. Transcription, Genetic. Tumor Cells, Cultured. Virus Replication. Xenograft Model Antitumor Assays. eIF-2 Kinase / antagonists & inhibitors. eIF-2 Kinase / physiology

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  • (PMID = 12810644.001).
  • [ISSN] 0008-5472
  • [Journal-full-title] Cancer research
  • [ISO-abbreviation] Cancer Res.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / P30 CA21765
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Eukaryotic Initiation Factor-2; 0 / Luminescent Proteins; 0 / Neoplasm Proteins; 147336-22-9 / Green Fluorescent Proteins; EC 2.7.11.1 / eIF-2 Kinase; EC 3.6.5.2 / HRAS protein, human; EC 3.6.5.2 / Proto-Oncogene Proteins p21(ras)
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5. Kawataki T, Sato E, Sato T, Kinouchi H: Anaplastic ganglioglioma with malignant features in both neuronal and glial components--case report. Neurol Med Chir (Tokyo); 2010;50(3):228-31
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  • [Title] Anaplastic ganglioglioma with malignant features in both neuronal and glial components--case report.
  • A 34-year-old man presented with a case of anaplastic ganglioglioma with malignant features in both neuronal and glial components manifesting as seizure episodes over 11 months.
  • The tumor was subtotally removed, followed by irradiation and chemotherapy.
  • Two months later, the tumor recurred with more pleomorphic appearance and higher cellularity with increased nestin expression level.
  • Cytological examination found dissemination to the leptomeningeal space.
  • The expression of nestin may suggest that the origin or malignant transformation in anaplastic gangliogliomas is related to the undifferentiated neural stem cells.
  • [MeSH-major] Brain Neoplasms / pathology. Ganglioglioma / pathology. Intermediate Filament Proteins / metabolism. Neoplasm Proteins / metabolism. Nerve Tissue Proteins / metabolism. Neuroglia / pathology. Neurons / pathology
  • [MeSH-minor] Adult. Anaplasia. Fatal Outcome. Humans. Male. Neoplasm Recurrence, Local. Nestin. Seizures / etiology. Seizures / pathology. Temporal Lobe / cytology. Temporal Lobe / metabolism. Temporal Lobe / pathology

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  • (PMID = 20339274.001).
  • [ISSN] 1349-8029
  • [Journal-full-title] Neurologia medico-chirurgica
  • [ISO-abbreviation] Neurol. Med. Chir. (Tokyo)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Intermediate Filament Proteins; 0 / NES protein, human; 0 / Neoplasm Proteins; 0 / Nerve Tissue Proteins; 0 / Nestin
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6. Rogers LR, Remer SE, Tejwani S: Durable response of breast cancer leptomeningeal metastasis to capecitabine monotherapy. Neuro Oncol; 2004 Jan;6(1):63-4
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  • [Title] Durable response of breast cancer leptomeningeal metastasis to capecitabine monotherapy.
  • We report a durable (12-month) response to capecitabine monotherapy, shown clinically, by MRI, and by cerebrospinal fluid analysis, in a patient with leptomeningeal metastasis from breast cancer.
  • [MeSH-major] Antimetabolites, Antineoplastic / therapeutic use. Brain Neoplasms / secondary. Breast Neoplasms / drug therapy. Deoxycytidine / analogs & derivatives. Deoxycytidine / therapeutic use. Meningeal Neoplasms / drug therapy. Meningeal Neoplasms / secondary. Orbital Neoplasms / secondary
  • [MeSH-minor] Adult. Capecitabine. Female. Fluorouracil / analogs & derivatives. Humans. Treatment Outcome

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  • (PMID = 14769142.001).
  • [ISSN] 1522-8517
  • [Journal-full-title] Neuro-oncology
  • [ISO-abbreviation] Neuro-oncology
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 0W860991D6 / Deoxycytidine; 6804DJ8Z9U / Capecitabine; U3P01618RT / Fluorouracil
  • [Other-IDs] NLM/ PMC1871963
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7. Mehta M, Bradley K: Radiation therapy for leptomeningeal cancer. Cancer Treat Res; 2005;125:147-58
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  • [Title] Radiation therapy for leptomeningeal cancer.
  • Radiotherapy has multiple roles in the treatment of leptomeningeal cancer.
  • While it is uncommon for patients to experience regression of neurologic deficits due to leptomeningeal cancer, focal radiotherapy often provides significant palliation of pain, increased intracranial pressure and other focal symptoms.
  • Focal radiotherapy may also be used to eliminate blockages of cerebrospinal fluid (CSF) and allow for safe administration of intrathecal chemotherapy.
  • Craniospinal irradiation (CSI) is most often used as prophylaxis for patients at high risk of leptomeningeal tumor dissemination, but may result in symptom palliation and prolonged disease control for patients with active leptomeningeal tumor.

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  • (PMID = 16211888.001).
  • [ISSN] 0927-3042
  • [Journal-full-title] Cancer treatment and research
  • [ISO-abbreviation] Cancer Treat. Res.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 26
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8. Kochi M, Itoyama Y, Shiraishi S, Kitamura I, Marubayashi T, Ushio Y: Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors. J Neurosurg; 2003 Jul;99(1):106-14
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  • [Title] Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors.
  • OBJECT: The goal of this study was to confirm the effectiveness of our novel treatment strategy, neoadjuvant therapy (NAT) consisting of combined chemo- and radiotherapy, which are performed before complete excision of residual tumor in patients with intracranial nongerminomatous malignant germ cell tumors (NGMGCTs).
  • METHODS: The authors treated 11 consecutive patients with NGMGCTs by applying NAT consisting of combined platinum-based chemotherapy and radiotherapy, followed by complete excision of residual tumors.
  • The pretreatment diagnosis, based on tumor markers with or without biopsy, was yolk sac tumor in five patients, embryonal carcinoma in one patient, immature teratoma in one patient, and mixed germ cell tumor containing malignant tumor components in four patients.
  • In one patient a leptomeningeal tumor recurred and he died of the disease 21 months after diagnosis.
  • CONCLUSIONS: Neoadjuvant therapy, consisting of combined chemo- and radiotherapy, followed by complete excision of residual tumors is highly effective in patients with intracranial NGMGCTs.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Brain Neoplasms. Carcinoma. Endodermal Sinus Tumor. Germinoma. Neoadjuvant Therapy / methods. Neoplasms, Germ Cell and Embryonal
  • [MeSH-minor] Adolescent. Adult. Biomarkers, Tumor. Biopsy. Child. Combined Modality Therapy. Disease Progression. Drug Administration Schedule. Female. Humans. Magnetic Resonance Imaging. Male. Neoplasm, Residual / pathology. Neoplasm, Residual / surgery. Postoperative Care. Quality of Life. Treatment Outcome

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  • (PMID = 12854751.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor
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9. Drappatz J, Batchelor TT: Leptomeningeal neoplasms. Curr Treat Options Neurol; 2007 Jul;9(4):283-93
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  • [Title] Leptomeningeal neoplasms.
  • Leptomeningeal metastasis is becoming an increasingly important late complication of cancer as survival from systemic disease increases, and due to the fact that many novel cancer drugs fail to achieve therapeutic concentrations in the central nervous system.
  • Definitive diagnosis is established by the demonstration of malignant cells in the CSF.
  • However, in certain circumstances the presence of leptomeningeal enhancement on brain or spinal MRI may be sufficient to make the diagnosis.
  • Early diagnosis and aggressive treatment may delay neurologic progression and can lead to prolonged survival and improvement of neurologic function in certain patients.
  • The prognosis depends on the underlying malignancy but is often poor, with a median survival of 4 months, and most treatment interventions are palliative.
  • Nevertheless, some patients respond to treatment, and some survive beyond 1 or 2 years after diagnosis.
  • Areas of radiographic bulky disease or symptomatic tumor should receive radiotherapy.
  • Intrathecal chemotherapy is most effective in patients with lymphoma, leukemia, or breast cancer and without evidence of bulky disease on neuroimaging.
  • Intrathecal chemotherapy requires normal CSF flow, and the most commonly used agents are methotrexate, cytarabine, and thiotepa.
  • In lieu of intrathecal therapy, systemic chemotherapy may occasionally be indicated in select patients in part based on its ability to penetrate into bulky disease.
  • There is hope that progress in diagnostic modalities and the development of more effective intrathecal antineoplastic drugs may decrease neurologic morbidity and improve quality of life and survival.

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  • (PMID = 17580008.001).
  • [ISSN] 1092-8480
  • [Journal-full-title] Current treatment options in neurology
  • [ISO-abbreviation] Curr Treat Options Neurol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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10. Clatot F, Philippin-Lauridant G, Ouvrier MJ, Nakry T, Laberge-Le-Couteulx S, Guillemet C, Veyret C, Blot E: Clinical improvement and survival in breast cancer leptomeningeal metastasis correlate with the cytologic response to intrathecal chemotherapy. J Neurooncol; 2009 Dec;95(3):421-426
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  • [Title] Clinical improvement and survival in breast cancer leptomeningeal metastasis correlate with the cytologic response to intrathecal chemotherapy.
  • Leptomeningeal meningitis occurs in approximately 5% of metastatic breast cancers, and there is no standard treatment for this complication.
  • We retrospectively analyzed the clinical data and cerebrospinal fluid of 24 patients treated with high-dose intrathecal methotrexate for breast cancer leptomeningeal meningitis (BLM).
  • Cytologic response (CSF cytology without neoplastic cells after treatment) was observed in 11 patients (46%) and related to survival (P = 0.005).
  • Cytologic response could be helpful in the management of intrathecal chemotherapy in patients with BLM.
  • [MeSH-minor] Adult. Aged. Cerebrospinal Fluid / cytology. Female. Humans. Injections, Spinal. Middle Aged. Neoplasm Staging. Predictive Value of Tests. Prognosis. Retrospective Studies. Survival Analysis

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  • (PMID = 19557501.001).
  • [ISSN] 1573-7373
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; YL5FZ2Y5U1 / Methotrexate
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11. DeAngelis LM, Boutros D: Leptomeningeal metastasis. Cancer Invest; 2005;23(2):145-54
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Leptomeningeal metastasis.
  • Leptomeningeal metastasis is a common complication of cancer.
  • Often the diagnosis can be difficult, but early diagnosis and aggressive treatment can prevent irreversible neurologic deficits.
  • Diagnosis is usually established by the demonstration of malignant cells in the cerebrospinal fluid (CSF) or by the presence of enhancing tumor nodules on cranial or spinal MRI.
  • Treatment may require focal radiotherapy to symptomatic sites accompanied by chemotherapy.
  • Intra-CSF chemotherapy requires normal CSF flow dynamics and is typically limited to the use of methotrexate, cytarabine or thiotepa.
  • Intrathecal chemotherapy is rarely efficacious, except for hematopoietic neoplasms and, to a lesser extent, breast cancer.
  • Increasingly, systemic chemotherapy is recognized as efficacious in the treatment of leptomeningeal metastasis in part because it has the ability to penetrate into bulky disease seen on neuroimaging.
  • The optimum choice of therapy depends upon a thorough assessment of the neurologic extent of disease, which should include complete neuraxis imaging.
  • Patients with extensive bulky disease may be best treated with systemic chemotherapy, whereas those with a positive CSF cytology but negative imaging may be treated with intrathecal chemotherapy and spared the systemic toxicity of intravenous drug.
  • Despite vigorous therapy, many patients do poorly and the median survival is only about four months.
  • Nevertheless, some patients, particularly those with leukemia, lymphoma, and breast cancer, respond and a substantial minority will be alive one to two years after diagnosis.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Meningeal Neoplasms / drug therapy. Meningeal Neoplasms / secondary

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  • (PMID = 15813508.001).
  • [ISSN] 0735-7907
  • [Journal-full-title] Cancer investigation
  • [ISO-abbreviation] Cancer Invest.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 65
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12. Endo H, Kumabe T, Jokura H, Shirane R, Ariga H, Takai Y, Yoshimoto T: Leptomeningeal dissemination of cerebellar malignant astrocytomas. J Neurooncol; 2003 Jun;63(2):191-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Leptomeningeal dissemination of cerebellar malignant astrocytomas.
  • Primary malignant astrocytomas of the cerebellum are extremely rare, and the dissemination patterns and effectiveness of postoperative radiation therapy are unclear.
  • Five consecutive cases of histologically proven cerebellar malignant astrocytoma, two anaplastic astrocytomas, one anaplastic pilocytic astrocytoma, and two glioblastomas, were treated between 1997 and 2001.
  • Four patients underwent surgical removal, local irradiation, and chemotherapy, and one patient with anaplastic pilocytic astrocytoma received subtotal removal followed by gamma knife radiosurgery for the residual tumor.
  • All patients developed leptomeningeal dissemination.
  • The time interval between the diagnosis of the primary cerebellar tumor and the diagnosis of leptomeningeal dissemination was 5-29 months (mean 14.6 +/- 10.4 months).
  • Intensive treatment including chemotherapy and radiotherapy may be required in cerebellar malignant astrocytomas, considering the high incidence of symptomatic leptomeningeal dissemination.
  • [MeSH-minor] Adult. Aged. Cerebral Ventricles / pathology. Child. Female. Humans. Magnetic Resonance Imaging. Middle Aged. Survival Rate. Treatment Outcome

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  • (PMID = 12825824.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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13. Norris LS, Snodgrass S, Miller DC, Wisoff J, Garvin J, Rorke LB, Finlay JL: Recurrent central nervous system medulloepithelioma: response and outcome following marrow-ablative chemotherapy with stem cell rescue. J Pediatr Hematol Oncol; 2005 May;27(5):264-6
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Recurrent central nervous system medulloepithelioma: response and outcome following marrow-ablative chemotherapy with stem cell rescue.
  • Medulloepithelioma is a rare primitive neuroectodermal tumor of the central nervous system usually developing in childhood, displaying highly malignant behavior, with early progression or recurrence.
  • The purpose of this study was to evaluate the efficacy of high-dose, marrow-ablative chemotherapy with autologous hemopoietic stem cell rescue in the treatment of recurrent central nervous system medulloepithelioma.
  • Three young children with recurrent central nervous system medulloepithelioma received high-dose marrow-ablative chemotherapy with thiotepa and etoposide either alone (one patient) or with the addition of carboplatin (two patients).
  • One child with residual radiographic tumor at the time of treatment could be evaluated for response and showed complete resolution of leptomeningeal disease after receiving marrow-ablative chemotherapy.
  • Two children developed tumor recurrence at 2.0 and 5.5 months after receiving marrow-ablative chemotherapy.
  • The third child continues free of tumor beyond 12 years from treatment.
  • The authors' experience with marrow-ablative chemotherapy and autologous hemopoietic stem cell rescue suggests that this treatment strategy might be beneficially incorporated into the initial treatment approach for young children with medulloepithelioma.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carcinoma / therapy. Central Nervous System Neoplasms / therapy. Neoplasm Recurrence, Local. Stem Cell Transplantation
  • [MeSH-minor] Child, Preschool. Combined Modality Therapy. Female. Humans. Magnetic Resonance Imaging. Male. Time Factors. Treatment Outcome

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  • (PMID = 15891561.001).
  • [ISSN] 1077-4114
  • [Journal-full-title] Journal of pediatric hematology/oncology
  • [ISO-abbreviation] J. Pediatr. Hematol. Oncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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14. Chowdhary S, Chamberlain M: Leptomeningeal metastases: current concepts and management guidelines. J Natl Compr Canc Netw; 2005 Sep;3(5):693-703

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Leptomeningeal metastases: current concepts and management guidelines.
  • Neoplastic infiltration of the meninges occurs when malignant cells gain entry into the cerebrospinal fluid (CSF).
  • This is clinically recognized in 4% to 7% of all cancer patients.
  • Leptomeningeal metastases may involve any part of the neural axis via tumor seeding; thus, a multitude of clinical presentations involving one or more domains exist, including the cerebral hemisphere, cranial nerves, and spinal cord and roots.
  • Adequate cytologic analysis of CSF fluid, neuroradiography of brain and spine, and an appropriate clinical context are the key element in diagnosing leptomeningeal metastases.
  • Treatment is palliative and involves stabilizing neurologic status and prolonging survival.
  • Treatment in a broad perspective entails radiotherapy and chemotherapy (systemic and intra-CSF).
  • Commonly used intra-CSF chemotherapy regimens use drugs such as methotrexate, cytarabine, thiotepa, and a sustained-release liposome-encapsulated form of cytarabine (Depocyt, SkyePharma, London, UK).
  • Patients with neoplastic meningitis usually experience a limited survival, even when treated using close adherence to evaluation algorithms and treatment protocols.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Meningeal Neoplasms / drug therapy. Meningeal Neoplasms / secondary
  • [MeSH-minor] Algorithms. Combined Modality Therapy. Diagnosis, Differential. Humans. Palliative Care. Prognosis. Survival Analysis

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  • (PMID = 16194457.001).
  • [ISSN] 1540-1405
  • [Journal-full-title] Journal of the National Comprehensive Cancer Network : JNCCN
  • [ISO-abbreviation] J Natl Compr Canc Netw
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 100
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15. Ortega-Martínez M, Cabezudo-Artero JM, Fernández-Portales I, Pimentel JJ, Gómez de Tejada R: Diffuse leptomeningeal seeding from benign choroid plexus papilloma. Acta Neurochir (Wien); 2007 Dec;149(12):1229-36; discussion 1236-7
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Diffuse leptomeningeal seeding from benign choroid plexus papilloma.
  • Although they are histologically benign, local recurrences may occasionally occur, but leptomeningeal dissemination is exceptional.
  • We report an unusual example of a fourth ventricle choroid plexus papilloma with diffuse leptomeningeal seeding.
  • Neither the initial tumour nor the recurrence showed malignant histological features.
  • Treatment with systemic and intrathecal chemotherapy was ineffective in this patient.
  • We review the literature concerning leptomeningeal dissemination of benign choroid plexus papillomas.
  • [MeSH-major] Cerebral Ventricle Neoplasms / surgery. Fourth Ventricle / surgery. Meningeal Neoplasms / secondary. Neoplasm Seeding. Papilloma, Choroid Plexus / surgery
  • [MeSH-minor] Adult. Biomarkers, Tumor / analysis. Biopsy. Disease Progression. Fatal Outcome. Female. Humans. Ki-67 Antigen / analysis. Laminectomy. Magnetic Resonance Imaging. Meninges / pathology. Reoperation. S100 Proteins / analysis

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  • (PMID = 17924056.001).
  • [ISSN] 0942-0940
  • [Journal-full-title] Acta neurochirurgica
  • [ISO-abbreviation] Acta Neurochir (Wien)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Austria
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Ki-67 Antigen; 0 / S100 Proteins
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16. Partap S, Murphy PA, Vogel H, Barnes PD, Edwards MS, Fisher PG: Efficacy and tolerability of intrathecal liposomal cytarabine for central nervous system embryonal tumors. J Clin Oncol; 2009 May 20;27(15_suppl):2064

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • : 2064 Background: Liposomal cytarabine (DepoCyt) is a sustained-release intrathecal (IT) preparation of cytarabine, formulated by encapsulating the drug in spherical aqueous chambers within a lipid matrix.
  • While proven effective in lymphomatous meningitis, this drug has shown some activity in medulloblastoma (MB) with spinal metastases in limited pediatric phase I study.
  • METHODS: We reviewed all patients at our institution treated with liposomal cytarabine for primary central nervous system (CNS) embryonal tumors-MB, primitive neuroectodermal tumor (PNET), and atypical teratoid rhabdoid tumor (ATRT).
  • RESULTS: A cohort of 17 patients were treated with liposomal cytarabine at diagnosis of CNS embryonal tumor (2 PNET, 3 ATRT) or relapse (12 MB [7 average-risk, 5 high-risk]); nine had leptomeningeal metastases.
  • Drug was dosed at 2 mg/kg up to 50, every 2 weeks to monthly, along with dexamethasone.
  • Concurrent systemic chemotherapy was given in 16 patients.
  • A total of 102 doses were administered (lumbar IT 76, Ommaya intraventricular 36) with a mean of six treatments (range 1-16).
  • All six evaluable patients with malignant cerebrospinal fluid (CSF) cytology and treated with at least two doses cleared their spinal fluid (mean 3 doses, range 1-5).
  • No patient developed malignant CSF cytology while receiving liposomal cytarabine.
  • Ten patients developed progressive disease and died, with only one later recurrence in the spinal fluid.
  • All patients with neoplastic meningitis cleared malignant cells from their spinal fluid after treatment with IT liposomal cytarabine and systemic chemotherapy.

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  • (PMID = 27964690.001).
  • [ISSN] 1527-7755
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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17. Jaeckle KA: Improving the outcome of patients with leptomeningeal cancer: new clinical trials and experimental therapies. Cancer Treat Res; 2005;125:181-93
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Improving the outcome of patients with leptomeningeal cancer: new clinical trials and experimental therapies.
  • Current therapy for leptomeningeal metastases is predominantly palliative.
  • In an effort to improve disease control and patient outcome, new strategies are being developed to target the cerebrospinal space.
  • These include new intrathecal formulations of systemic chemotherapy as well as the development of radiolabeled immunoconjugates and antitumor antibodies.
  • Furthermore, there is debate as to the optimal strategy of drug delivery for leptomeningeal tumor.
  • [MeSH-major] Meningeal Neoplasms / drug therapy
  • [MeSH-minor] Antineoplastic Agents / administration & dosage. Antineoplastic Agents / therapeutic use. Clinical Trials as Topic / methods. Clinical Trials as Topic / trends. Humans. Injections, Spinal. Treatment Outcome

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  • (PMID = 16211890.001).
  • [ISSN] 0927-3042
  • [Journal-full-title] Cancer treatment and research
  • [ISO-abbreviation] Cancer Treat. Res.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents
  • [Number-of-references] 50
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18. Hill MD, Mackenzie I, Mason WP: Radiation-induced glioma presenting as diffuse leptomeningeal gliomatosis: a case report. J Neurooncol; 2001 Nov;55(2):113-6
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  • [Title] Radiation-induced glioma presenting as diffuse leptomeningeal gliomatosis: a case report.
  • BACKGROUND: Leptomeningeal gliomatosis is a rare and fatal disease.
  • RESULTS: We report the case of a man who was presented with severe intractable headaches, lymphocytic CSF pleocytosis, and spinal leptomeningeal enhancement on contrast MRI.
  • Meningeal biopsy demonstrated diffuse infiltration by malignant glial cells, and symptom alleviation was achieved by CSF diversion.
  • He later developed an enhancing thalamic tumor arising within the treatment field of a remotely irradiated pituitary adenoma.
  • Subsequent management included chemotherapy and further radiotherapy with transient response, before death from leptomeningeal and parenchymal tumor progression 16 months after diagnosis.
  • CONCLUSION: We report a unique case embodying two rare conditions: radiation induced glioma and leptomeningeal gliomatosis.
  • Our patient's course is novel in that symptomatic relief was achieved with CSF diversion and a combination of chemotherapy and focal radiation allowed prolonged survival.
  • [MeSH-minor] Adult. Antineoplastic Agents / therapeutic use. Cerebrospinal Fluid Shunts. Combined Modality Therapy. Fatal Outcome. Humans. Magnetic Resonance Imaging. Male

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  • (PMID = 11817701.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents
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19. Kleinschmidt-DeMasters BK, Damek DM: The imaging and neuropathological effects of Bevacizumab (Avastin) in patients with leptomeningeal carcinomatosis. J Neurooncol; 2010 Feb;96(3):375-84
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] The imaging and neuropathological effects of Bevacizumab (Avastin) in patients with leptomeningeal carcinomatosis.
  • Bevacizumab (Avastin, Genetech/Roche) is an anti-angiogenic drug approved for treating patients with malignant gliomas that reduces edema and mass effect, but has been suggested to promote multifocal tumor spread within the brain.
  • Patients with systemic malignancies are also treated with bevacizumab, but there is limited information regarding effects of the drug on the neuroimaging or neuropathological features of metastatic CNS disease.
  • We report 2 patients with non-small cell lung carcinomas who had received bevacizumab for their systemic cancers and then developed cognitive deficits consistent with white matter dementia.
  • Diagnosis of leptomeningeal carcinomatosis (LC) was confounded and delayed by the finding of atypical neuroimaging features, including minimal to absent leptomeningeal enhancement and unusual perivascular and punctate hemorrhagic lesions and multifocal subgyral signal abnormalities suspicious for vasculitis or small vessel vasculopathy.
  • Neuropathological assessment confirmed LC but, in the autopsy case also disclosed extraordinary perivascular spread of individual metastatic tumor cells to the depth of capillaries.
  • The pattern was reminiscent of vascular "cooption" by tumor seen in experimental animals in preclinical trials of bevacizumab.
  • Small infarctions were associated with perivascular tumor and vasculopathy, unusual features of LC in patients who do not receive bevacizumab.
  • In the biopsied patient, multiple perivascular tumor nodules were identified in superficial cortex.
  • In these two patients, bevacizumab appeared to alter neuroimaging characteristics of LC, confounded diagnosis and possibly also influenced the pattern of tumor spread of LC.
  • [MeSH-major] Angiogenesis Inhibitors / therapeutic use. Antibodies, Monoclonal / therapeutic use. Brain / pathology. Meningeal Carcinomatosis / drug therapy. Meningeal Carcinomatosis / pathology

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  • (PMID = 19609489.001).
  • [ISSN] 1573-7373
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Angiogenesis Inhibitors; 0 / Antibodies, Monoclonal; 0 / Antibodies, Monoclonal, Humanized; 2S9ZZM9Q9V / Bevacizumab
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20. Oechsle K, Lange-Brock V, Kruell A, Bokemeyer C, de Wit M: Prognostic factors and treatment options in patients with leptomeningeal metastases of different primary tumors: a retrospective analysis. J Cancer Res Clin Oncol; 2010 Nov;136(11):1729-35

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Prognostic factors and treatment options in patients with leptomeningeal metastases of different primary tumors: a retrospective analysis.
  • PURPOSE: Leptomeningeal metastases (LM) are associated with very poor prognosis and data on outcome are limited.
  • We evaluated prognostic factors and treatment options in patients (pts) with LM of different malignancies in a single center experience.
  • METHODS: Single center data on characteristics, treatment and outcome of 135 consecutive pts (73 solid tumors and 62 hematologic malignancies) with LM between 1989 and 2005 were retrospectively analyzed.
  • RESULTS: Treatment consisted of systemic chemotherapy (SC) plus intrathecal chemotherapy (ITC) in 28%, ITC alone in 22%, radiotherapy (RT) plus ITC in 12% and other modalities (SC, RT, SC + RT) in 7%.
  • Thirteen percent of pts received supportive care only (4% not evaluable on treatment).
  • Univariate analysis revealed age >50, interval between diagnosis of primary tumor and LM ≤12 months, lung cancer and malignant melanoma, and Karnofsky performance status ≤70 as significant negative predictors for overall survival.
  • CONCLUSIONS: In patients with LM an age >50, performance status ≤70%, interval between diagnosis of primary tumor and LM ≤12 months, primary tumor (lung cancer, malignant melanoma) and lack of cytologic response present negative prognostic factors.
  • Systemic chemotherapy is significantly associated with longer survival time than local treatment modalities.
  • [MeSH-major] Meningeal Carcinomatosis / pathology. Neoplasm Metastasis / pathology
  • [MeSH-minor] Adolescent. Adult. Aged. Combined Modality Therapy. Female. Hematologic Neoplasms / drug therapy. Hematologic Neoplasms / mortality. Hematologic Neoplasms / pathology. Humans. Lung Neoplasms / drug therapy. Lung Neoplasms / mortality. Lung Neoplasms / pathology. Lung Neoplasms / radiotherapy. Male. Melanoma / drug therapy. Melanoma / mortality. Melanoma / pathology. Melanoma / radiotherapy. Middle Aged. Neoplasms / drug therapy. Neoplasms / mortality. Neoplasms / pathology. Prognosis. Proportional Hazards Models. Retrospective Studies. Survival Analysis

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  • (PMID = 20204406.001).
  • [ISSN] 1432-1335
  • [Journal-full-title] Journal of cancer research and clinical oncology
  • [ISO-abbreviation] J. Cancer Res. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Germany
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21. Roldán G, Scott J, George D, Parney I, Easaw J, Cairncross G, Forsyth P, Yan E: Leptomeningeal disease from oligodendroglioma: clinical and molecular analysis. Can J Neurol Sci; 2008 May;35(2):204-9
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  • [Title] Leptomeningeal disease from oligodendroglioma: clinical and molecular analysis.
  • BACKGROUND: Leptomeningeal disease (LMD) is a late complication of malignant glioma, mostly of glioblastoma, that usually responds poorly to treatment and is rapidly fatal.
  • Median age at tumor diagnosis was 41 years (range, 28-50).
  • None had radiographic or pathological evidence of leptomeningeal or subependymal tumor at initial diagnosis.
  • The median time to first relapse was 41 months (range, 19-127).
  • The median time to LMD was 76 months (range, 19-151) from initial diagnosis and 28 months (range, 0-36) from first relapse, respectively.
  • Leptomeningeal disease treatments included spinal radiation and intrathecal and systemic chemotherapy.
  • CONCLUSIONS: Leptomeningeal disease is a complication of oligodendroglioma that may occur preferentially in long surviving patients with 1p/19q co-deletion.
  • Leptomeningeal disease in patients with oligodendrogliomas appears to be relatively indolent which may have implications for their treatment and be related to 1p/19q status.

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  • (PMID = 18574935.001).
  • [ISSN] 0317-1671
  • [Journal-full-title] The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques
  • [ISO-abbreviation] Can J Neurol Sci
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Canada
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22. Martin-Blondel G, Rousseau A, Boch AL, Cacoub P, Sène D: Primary pineal melanoma with leptomeningeal spreading: case report and review of the literature. Clin Neuropathol; 2009 Sep-Oct;28(5):387-94
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  • [Title] Primary pineal melanoma with leptomeningeal spreading: case report and review of the literature.
  • Magnetic resonance imaging revealed a pineal mass hyperintense on T1-weighted and isointense on T2-weighted sequences with diffuse leptomeningeal involvement and intense homogeneous contrast enhancement after gadolinium administration.
  • A frontal leptomeningeal and cortical biopsy was performed.
  • Histological examination showed a malignant melanocytic tumor cell proliferation expressing Melan-A, but not HMB-45 or S100 protein.
  • Even if we have no proof that the tumor actually arose in the pineal gland, based on the radiological and histological findings, and on the unremarkable dermatologic and ophthalmologic examinations, a primary pineal melanoma with leptomeningeal dissemination was diagnosed.
  • The patient received temozolomide-based chemotherapy followed by whole brain irradiation.
  • The patient died 52 weeks after disease onset and 13 weeks after treatment initiation.
  • The diagnosis is provided by pathological examination of tumor specimens obtained at surgical resection or at leptomeningeal biopsy.
  • However, immunochemistry using anti-Melan-A, -S100 protein and/or -HMB45 antibodies on cerebrospinal fluid and leptomeningeal samples may be helpful in diagnosing such a disease.
  • The best therapeutic management is yet to be defined.
  • [MeSH-minor] Adult. Antigens, Neoplasm / metabolism. Brain / pathology. Brain / radiography. Brain / radionuclide imaging. Diagnosis, Differential. Fatal Outcome. Humans. MART-1 Antigen. Magnetic Resonance Imaging. Male. Melanoma-Specific Antigens. Neoplasm Proteins / metabolism. Prognosis. S100 Proteins / metabolism

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  • (PMID = 19788056.001).
  • [ISSN] 0722-5091
  • [Journal-full-title] Clinical neuropathology
  • [ISO-abbreviation] Clin. Neuropathol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Antigens, Neoplasm; 0 / MART-1 Antigen; 0 / MLANA protein, human; 0 / Melanoma-Specific Antigens; 0 / Neoplasm Proteins; 0 / S100 Proteins
  • [Number-of-references] 20
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23. Toledano Delgado R, Garcia N, Riva-Amarante E, Rodríguez Pascual J, García Leal R, Sendra Tello J: [Spinal leptomeningeal metastasis from cerebral glioblastoma: case report]. Neurologia; 2006 Sep;21(7):378-81
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  • [Title] [Spinal leptomeningeal metastasis from cerebral glioblastoma: case report].
  • INTRODUCTION: Glioblastoma multiforme (GBM) is the most common primary malignant tumor of the central nervous system.
  • Spinal leptomeningeal metastasis (SLM) due to a GBM are well documented at autopsy in patients previously diagnosed of GBM, however, systemic dissemination with symptomatic leptomeningeal metastasis is quite rare.
  • Most of the time it is diagnosed late and misdiagnosis is a common problem.
  • CASE REPORT: We present a case of a 65-year-old man with a right temporal GBM treated by surgical resection, radiotherapy and chemotherapy, who is readmitted 10 months later as he developed an ataxic gait.
  • Awareness of this complication might facilitate more rapid diagnosis and treatment.
  • [MeSH-minor] Aged. Humans. Lumbar Vertebrae / pathology. Male. Neoplasm Invasiveness

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  • (PMID = 16977559.001).
  • [ISSN] 0213-4853
  • [Journal-full-title] Neurología (Barcelona, Spain)
  • [ISO-abbreviation] Neurologia
  • [Language] spa
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Spain
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24. Fridley JS, Chamoun RB, Whitehead WE, Curry DJ, Luerssen TG, Adesina A, Jea A: Malignant rhabdoid tumor of the spine in an infant: case report and review of the literature. Pediatr Neurosurg; 2009;45(3):237-43
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  • [Title] Malignant rhabdoid tumor of the spine in an infant: case report and review of the literature.
  • Malignant rhabdoid tumors of the spine are rare pediatric neoplasms that have a poor prognosis.
  • We report the case of a malignant rhabdoid tumor of the cervical spine in a 13-month-old infant.
  • Tumor cells were vimentin positive with prominent nucleoli indented by eosinophilic cytoplasmic inclusions containing intermediate filaments.
  • Despite chemotherapy, she developed worsening leptomeningeal dissemination, lower cranial nerve dysfunction, and hydrocephalus that did not respond to CSF diversion.
  • We review the literature on spinal malignant rhabdoid tumor and discuss the nomenclature, pathology, radiology, treatment, and outcomes of this rare entity.
  • [MeSH-major] Magnetic Resonance Imaging. Rhabdoid Tumor / pathology. Spinal Neoplasms / pathology

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  • [Copyright] Copyright 2009 S. Karger AG, Basel.
  • (PMID = 19521139.001).
  • [ISSN] 1423-0305
  • [Journal-full-title] Pediatric neurosurgery
  • [ISO-abbreviation] Pediatr Neurosurg
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] Switzerland
  • [Number-of-references] 30
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25. Minchom A, Chan S, Melia W, Shah R: An unusual case of pancreatic cancer with leptomeningeal infiltration. J Gastrointest Cancer; 2010 Jun;41(2):107-9
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  • [Title] An unusual case of pancreatic cancer with leptomeningeal infiltration.
  • INTRODUCTION: Pancreatic cancer is a common malignancy and often presents at an advanced stage.
  • We aim to describe an unusual case of leptomeningeal involvement from pancreatic cancer.
  • MRI study of the brain and spinal cord showed widespread leptomeningeal enhancement.
  • He started on a weekly regimen of intrathecal combination chemotherapy of hydrocortisone 50 mg, methotrexate 12.5 mg and cytarabine 50 mg.
  • His clinical condition continued to deteriorate, cytotoxic therapy was withdrawn after 2 weeks and he died the following month.
  • DISCUSSION: This case represents the unusual presentation of advanced leptomeningeal carcinomatosis in a locally early stage pancreatic adenocarcinoma.
  • [MeSH-minor] Anti-Inflammatory Agents / administration & dosage. Antimetabolites, Antineoplastic / administration & dosage. Cytarabine / administration & dosage. Drug Therapy, Combination. Fatal Outcome. Humans. Hydrocortisone / administration & dosage. Male. Methotrexate / administration & dosage. Middle Aged

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  • (PMID = 20069465.001).
  • [ISSN] 1941-6636
  • [Journal-full-title] Journal of gastrointestinal cancer
  • [ISO-abbreviation] J Gastrointest Cancer
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Anti-Inflammatory Agents; 0 / Antimetabolites, Antineoplastic; 04079A1RDZ / Cytarabine; WI4X0X7BPJ / Hydrocortisone; YL5FZ2Y5U1 / Methotrexate
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26. Friedman JA, Lynch JJ, Buckner JC, Scheithauer BW, Raffel C: Management of malignant pineal germ cell tumors with residual mature teratoma. Neurosurgery; 2001 Mar;48(3):518-22; discussion 522-3
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Management of malignant pineal germ cell tumors with residual mature teratoma.
  • OBJECTIVE: The treatment of intracranial mixed germ cell tumors presents a unique challenge, since eradication of malignant tumor by radiation and/or chemotherapy may spare the benign tumor component.
  • We reviewed our surgical experience with residual malignant pineal germ cell tumors after neoadjuvant therapy.
  • METHODS: Between 1987 and 1997, 16 patients with malignant intracranial germ cell tumors were treated at the Mayo Clinic with a protocol of neoadjuvant chemotherapy and radiation therapy.
  • After the diagnosis was confirmed by histopathological examination, all patients were treated with four cycles of etoposide and cisplatin as well as external beam radiation therapy (range, 3030-5940 cGy).
  • Six patients had an incomplete response to therapy, as demonstrated by observation of residual tumor on magnetic resonance imaging scans.
  • Initial pathology in these six patients was germinoma in four and combinations of yolk sac tumor, embryonal carcinoma, malignant teratoma, and germinoma in two.
  • Two patients had synchronous pineal and suprasellar tumors, with leptomeningeal dissemination.
  • Tumor markers were elevated in four of the six patients at presentation.
  • CONCLUSION: Residual pineal tumor occurring after treatment of malignant intracranial germ cell tumor with neoadjuvant therapy is likely to be mature teratoma.
  • [MeSH-minor] Adolescent. Adult. Algorithms. Child. Combined Modality Therapy. Female. Follow-Up Studies. Humans. Male. Neoplasm, Residual


27. Rudnicka H, Niwińska A, Murawska M: Breast cancer leptomeningeal metastasis--the role of multimodality treatment. J Neurooncol; 2007 Aug;84(1):57-62
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  • [Title] Breast cancer leptomeningeal metastasis--the role of multimodality treatment.
  • AIM: The aim of the study was to assess the efficacy of multimodality treatment of patients with Leptomeningeal metastasis (LM) and to establish which method of treatment has the greatest positive impact on survival.
  • MATERIAL AND METHODS: Clinical material included 67 consecutive breast cancer patients with LM treated at the Cancer Center in Warsaw between the years 2000 and 2005.
  • Intrathecal chemotherapy was given to 57 pts (85%), intravenous chemotherapy to 41 pts (61%), whole brain radiotherapy to 33 pts (49%) and radiotherapy to the spinal leptomeninges to 10 (15%).
  • For 27 pts (40%) three methods of treatment were used.
  • Univariate and multivariate analyses were used to evaluate the impact of the particular method of treatment on survival and to assess the efficacy of combined modalities.
  • Univariate analysis showed positive impact of systemic intravenous chemotherapy (P = 0.0009), intrathecal chemotherapy (P = 0.008) and whole brain radiotherapy (P = 0.004) on survival.
  • The results of Cox multivariate analysis have shown systemic chemotherapy (P < 0.001) and intrathecal chemotherapy (P = 0.001) to be significant.
  • CONCLUSIONS: Intravenous chemotherapy and, independently, intrathecal chemotherapy improve survival in breast cancer patients with LM.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Breast Neoplasms / pathology. Carcinoma / secondary. Meningeal Neoplasms / secondary. Radiotherapy / methods
  • [MeSH-minor] Adult. Aged. Combined Modality Therapy / methods. Dexamethasone / administration & dosage. Disease-Free Survival. Humans. Infusions, Intravenous. Injections, Spinal. Kaplan-Meier Estimate. Methotrexate / administration & dosage. Middle Aged. Statistics, Nonparametric. Treatment Outcome

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  • (PMID = 17310266.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 7S5I7G3JQL / Dexamethasone; YL5FZ2Y5U1 / Methotrexate
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28. Hall WA: Targeted toxin therapy for malignant astrocytoma. Neurosurgery; 2000 Mar;46(3):544-51; discussion 552
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  • [Title] Targeted toxin therapy for malignant astrocytoma.
  • The poor prognosis associated with malignant astrocytoma has led investigators to seek new, innovative methods of treatment.
  • Targeted toxins represent a unique form of therapy that has two components, a carrier molecule with high specificity for tumor-associated antigens and a potent protein toxin.
  • These compounds are extremely cytotoxic to malignant astrocytoma cell lines in vitro.
  • Animal studies have shown prolongation of survival and complete tumor regression when targeted toxins were administered by a variety of routes.
  • The promising results seen in vivo have formed the basis for proceeding with clinical trials in humans with leptomeningeal neoplasia and malignant brain tumors, in which these agents are administered intrathecally or directly into tumor, respectively.
  • To date, in these clinical trials, targeted toxins have been delivered safely without significant neurological toxicity, and cytological analysis of cerebrospinal fluid and radiological findings have shown evidence of a therapeutic response.
  • These studies have confirmed the existence of a therapeutic window between normal brain tissue and malignant cells that can be exploited with targeted therapy directed against the transferrin receptor.
  • The successful delivery of targeted toxins directly into malignant brain tumors has established this route of administration as practical and feasible.
  • This chimeric fusion toxin is currently under investigation in a Phase I clinical trial with patients with recurrent malignant astrocytoma, and other targeted toxins are under development for the treatment of these uniformly fatal tumors.
  • Owing to these recent advances in targeted toxin therapy for malignant primary brain tumors, a review of the development of these agents for practicing neurosurgeons seems timely.
  • [MeSH-major] Astrocytoma / drug therapy. Brain Neoplasms / drug therapy. Immunotoxins / therapeutic use

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  • (PMID = 10719849.001).
  • [ISSN] 0148-396X
  • [Journal-full-title] Neurosurgery
  • [ISO-abbreviation] Neurosurgery
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / Immunotoxins
  • [Number-of-references] 33
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29. Alexiou GA, Moschovi M, Stefanaki K, Prodromou C, Sfakianos G, Prodromou N: Malignant progression of a pleomorphic xanthoastrocytoma in a child. Neuropediatrics; 2010 Aug;41(2):69-71
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  • [Title] Malignant progression of a pleomorphic xanthoastrocytoma in a child.
  • Pleomorphic xanthoastrocytoma (PXA) is a recently recognized rare cerebral neoplasm that predominantly affects young patients.
  • 1 year later follow-up magnetic resonance imaging (MRI) revealed tumor relapse.
  • An MRI of the spine was also performed and demonstrated leptomeningeal dissemination.
  • Histology revealed that the presence of a malignant PXA with anaplastic features.
  • The patient received radiotherapy and 9 months later on follow-up MRI a new tumor recurrence was noted.
  • A third craniotomy was performed and the tumor removed.
  • The patient was referred to the oncology department and received chemotherapy with temozolamide.
  • 8 months later the patient was stable without tumor recurrence.
  • [MeSH-minor] Child, Preschool. Disease Progression. Gadolinium. Humans. Magnetic Resonance Imaging. Male. Tomography, X-Ray Computed / methods

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  • [Copyright] Georg Thieme Verlag KG Stuttgart.New York.
  • (PMID = 20799153.001).
  • [ISSN] 1439-1899
  • [Journal-full-title] Neuropediatrics
  • [ISO-abbreviation] Neuropediatrics
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] AU0V1LM3JT / Gadolinium
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30. Canadè A, Magistrelli A, Lombardi R, Costantini M, Franceschini G, Belli P: Suspected cup syndrome. Diagnostic imaging of a misunderstood breast tumor for its uncommon location. Rays; 2003 Oct-Dec;28(4):379-85
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  • [Title] Suspected cup syndrome. Diagnostic imaging of a misunderstood breast tumor for its uncommon location.
  • On histology, a malignant parasternal nodule was diagnosed.
  • Breast MRI was performed and an ipsilateral malignant focal lesion was visualized.
  • Chemotherapy was administered but after a disease-free interval leptomeningeal and cerebral metastases appeared.

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  • (PMID = 15152540.001).
  • [ISSN] 0390-7740
  • [Journal-full-title] Rays
  • [ISO-abbreviation] Rays
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Italy
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31. van der Wal EJ, Azzarelli B, Edwards-Brown M: Malignant transformation of a chiasmatic pilocytic astrocytoma in a patient with diencephalic syndrome. Pediatr Radiol; 2003 Mar;33(3):207-10
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  • [Title] Malignant transformation of a chiasmatic pilocytic astrocytoma in a patient with diencephalic syndrome.
  • We report leptomeningeal spread of a chiasmatic pilocytic astrocytoma in a child presenting with diencephalic syndrome.
  • He was treated with chemotherapy and radiation.
  • The tumor recurred with transformation into a high-grade astrocytoma.
  • Radiation therapy may have played a role in transformation of the tumor, but more research is needed to further clarify the biological behavior of this tumor.
  • [MeSH-major] Astrocytoma / secondary. Cell Transformation, Neoplastic / pathology. Diencephalon / physiopathology. Meningeal Neoplasms / secondary. Neoplasm Invasiveness / pathology. Optic Chiasm / pathology. Optic Nerve Neoplasms / pathology
  • [MeSH-minor] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Biopsy, Needle. Child, Preschool. Combined Modality Therapy. Cranial Irradiation. Follow-Up Studies. Humans. Immunohistochemistry. Magnetic Resonance Imaging. Male. Risk Assessment. Syndrome

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  • (PMID = 12612823.001).
  • [ISSN] 0301-0449
  • [Journal-full-title] Pediatric radiology
  • [ISO-abbreviation] Pediatr Radiol
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Germany
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32. Debnam JM, Schellingerhout D, Kumar AJ, Ketonen L, Shah K, Hamberg LM, Hunter GJ: Multidetector CT-Guided Lumbar Puncture in Patients with Cancer. Interv Neuroradiol; 2009 Mar 31;15(1):61-6
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  • [Title] Multidetector CT-Guided Lumbar Puncture in Patients with Cancer.
  • SUMMARY: Lumbar puncture can be performed for therapeutic purposes, to instill intrathecal chemotherapy for leptomeningeal cancer treatment or prophylaxis.
  • The purpose of this article is to describe the technique and to evaluate outcomes of MDCT-guided lumber puncture for diagnostic and therapeutic purposes in patients with cancer.
  • We conclude that MDCT-guided lumbar puncture is an effective and safe guiding modality for thecal sac access in patients with cancer, particularly where other methods of intrathecal access have failed.

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  • (PMID = 20465930.001).
  • [ISSN] 1591-0199
  • [Journal-full-title] Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences
  • [ISO-abbreviation] Interv Neuroradiol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Other-IDs] NLM/ PMC3306150
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33. Zarovnaya EL, Pallatroni HF, Hug EB, Ball PA, Cromwell LD, Pipas JM, Fadul CE, Meyer LP, Park JP, Biegel JA, Perry A, Rhodes CH: Atypical teratoid/rhabdoid tumor of the spine in an adult: case report and review of the literature. J Neurooncol; 2007 Aug;84(1):49-55
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  • [Title] Atypical teratoid/rhabdoid tumor of the spine in an adult: case report and review of the literature.
  • Atypical teratoid/rhabdoid tumors (AT/RTs) are rare, malignant brain tumors which occur almost exclusively in infants and young children.
  • There have been only 17 cases of AT/RT in adults reported in the medical literature and the rarity of this tumor makes the diagnosis in adults difficult.
  • Subsequently, immunohistochemical studies revealed the absence of INI1 gene expression in the malignant cells, supporting the diagnosis of AT/RT.
  • The patient underwent three additional surgical procedures for recurrent disease throughout the neuraxis secondary to leptomeningeal spread of the tumor.
  • Despite aggressive surgical resection, adjuvant chemotherapy and radiation therapy, the patient succumbed to the disease two and a half years after her initial presentation.
  • To our knowledge, this is the first case of a spinal atypical teratoid/rhabdoid tumor in an adult fully documented with molecular, immunohistochemical, cytogenetic and autopsy findings.
  • [MeSH-major] Chromosomal Proteins, Non-Histone / genetics. Chromosomes, Human, Pair 22 / genetics. DNA-Binding Proteins / genetics. Neoplasm Recurrence, Local / pathology. Rhabdoid Tumor / pathology. Spinal Cord Neoplasms / pathology. Teratoma / pathology. Transcription Factors / genetics

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  • (PMID = 17377740.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA46274
  • [Publication-type] Case Reports; Journal Article; Research Support, N.I.H., Extramural; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chromosomal Proteins, Non-Histone; 0 / DNA-Binding Proteins; 0 / SMARCB1 Protein; 0 / SMARCB1 protein, human; 0 / Transcription Factors
  • [Number-of-references] 34
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34. Tentori L, Graziani G: Pharmacological strategies to increase the antitumor activity of methylating agents. Curr Med Chem; 2002 Jul;9(13):1285-301
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  • [Title] Pharmacological strategies to increase the antitumor activity of methylating agents.
  • Among methylating agents of clinical interest, temozolomide is a novel antitumor compound that has raised particular interest due to its acceptable safety profile and activity against tumors poorly responsive to conventional chemotherapy, such as malignant glioma and metastatic melanoma.
  • Moreover, the drug has recently shown promising antitumor activity in a patient affected by primary brain lymphoma and is currently under phase II clinical trials for leptomeningeal metastases from leukemia and lymphoma or for brain metastases from lung and breast cancers.
  • The antitumor activity of TMZ, that generates different types of methyl adducts (70% N7-methylguanine, 10% N3-methyladenine and 9% O6-methylguanine), has been mainly attributed to the formation of O6-methylguanine adducts.
  • Indeed, tumor cell susceptibility to TMZ is strongly affected by the functional status of DNA repair systems, involved either in the removal of methyl adducts from O6G or in the apoptotic signaling triggered by O6-methylG:T mispairs.
  • This review will focus on the different pharmacological strategies aimed at overcoming tumor resistance to TMZ such as new formulations of the drug or dosing schedules, and combined treatments with other chemotherapeutic agents, modulators of DNA repair systems, or gene therapy.
  • [MeSH-minor] Animals. Antineoplastic Combined Chemotherapy Protocols / pharmacology. Cell Cycle / drug effects. Combined Modality Therapy. DNA Methylation / drug effects. DNA Repair / drug effects. Humans. Mice. O(6)-Methylguanine-DNA Methyltransferase / antagonists & inhibitors

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  • (PMID = 12052167.001).
  • [ISSN] 0929-8673
  • [Journal-full-title] Current medicinal chemistry
  • [ISO-abbreviation] Curr. Med. Chem.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Review
  • [Publication-country] Netherlands
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Alkylating; 7GR28W0FJI / Dacarbazine; 85622-93-1 / temozolomide; EC 2.1.1.63 / O(6)-Methylguanine-DNA Methyltransferase
  • [Number-of-references] 196
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35. Lee O, Cromwell LD, Weider DJ: Carcinomatous meningitis arising from primary nasopharyngeal carcinoma. Am J Otolaryngol; 2005 May-Jun;26(3):193-7
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  • Carcinomatous meningitis, also known as leptomeningeal metastasis and meningeal carcinomatosis, is the invasion of neoplastic cells into the leptomeninges.
  • The patient was subsequently diagnosed with nasopharyngeal carcinoma by biopsy and treated with radiation as well as chemotherapy.
  • In 1993, magnetic resonance imaging scan of the head revealed recurrence of nasopharyngeal carcinoma with involvement of the ethmoid sinuses as well as extension of the tumor into the frontotemporal leptomeninges.
  • Although very rare, nasopharyngeal carcinoma can give rise to carcinomatous meningitis, probably by direct invasion of malignant cells.
  • We also review the literature with respect to the diagnosis and treatment of carcinomatosis meningitis.

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  • (PMID = 15858776.001).
  • [ISSN] 0196-0709
  • [Journal-full-title] American journal of otolaryngology
  • [ISO-abbreviation] Am J Otolaryngol
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Radioisotopes; AU0V1LM3JT / Gadolinium
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36. Lin C, Turner S, Gurney H, Peduto A: Increased detections of leptomeningeal presentations in men with hormone refractory prostate cancer: an effect of improved systemic therapy? J Med Imaging Radiat Oncol; 2008 Aug;52(4):376-81
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  • [Title] Increased detections of leptomeningeal presentations in men with hormone refractory prostate cancer: an effect of improved systemic therapy?
  • Metastases from prostate cancer occur largely in bone through a haematogenous route.
  • Metastatic spread of prostate cancer to the leptomeninges was rarely seen in the past.
  • However, there has been a recent increase in presentations of leptomeningeal spread from prostate cancer in our institutions.
  • Between 2004 and 2006, four patients were diagnosed with metastatic prostate cancer with leptomeningeal metastases in our centres.
  • All four patients had hormone refractory prostate cancer and had previously had chemotherapy.
  • The median survival of these patients was approximately 15 months from the time of hormone refractoriness.
  • The prognosis of leptomeningeal metastasis secondary to metastatic prostate cancer is poor, ranging from 2 to 7 months as seen in our series.
  • New cases of leptomeningeal metastases seen in our series are hypothesized to be secondary to the use of effective modern systemic treatments.
  • A parallel might be drawn with the increased rate of central nervous system metastases in breast cancer since the introduction of effective cytotoxic treatments and more recently targeted therapies.
  • We suggest the clinicians to be aware of the potential change of natural history and pattern of progression in metastatic prostate cancer.
  • [MeSH-minor] Aged. Hormones / therapeutic use. Humans. Male. Middle Aged

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  • (PMID = 18811763.001).
  • [ISSN] 1754-9485
  • [Journal-full-title] Journal of medical imaging and radiation oncology
  • [ISO-abbreviation] J Med Imaging Radiat Oncol
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Australia
  • [Chemical-registry-number] 0 / Hormones
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37. Koeller KK, Rushing EJ: From the archives of the AFIP: medulloblastoma: a comprehensive review with radiologic-pathologic correlation. Radiographics; 2003 Nov-Dec;23(6):1613-37
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  • Medulloblastoma is the most common pediatric central nervous system malignancy and the most common primary tumor of the posterior fossa in children.
  • This highly malignant neoplasm occurs more frequently in males and usually before 10 years of age.
  • Clinical symptoms and signs are generally brief, typically less than 3 months in duration, and reflect the strong predilection of this tumor to arise within the cerebellum, most often in the vermis.
  • Surgical resection, radiation therapy, and chemotherapy have substantially lowered the mortality associated with this tumor, with 5-year survival rates now commonly well above 50%.
  • Still, both dissemination at the time of diagnosis and recurrence remain obstacles in achieving a cure.
  • The tumor has characteristic hyperattenuation on unenhanced computed tomographic scans that reflects the high nuclear-cytoplasmic ratio seen at histologic analysis.
  • The tumor typically appears heterogeneous on images, findings that are related to cyst formation, hemorrhage, and calcification and that are even more pronounced with magnetic resonance (MR) imaging.
  • Evidence of leptomeningeal metastatic spread is present in 33% of all cases at the time of diagnosis and is well evaluated with contrast-enhanced MR imaging of the brain and the spine.
  • With continued research, treatment of these common neoplasms should improve, perhaps even achieving a cure in the future.
  • [MeSH-major] Cerebellar Neoplasms / radiography. Magnetic Resonance Imaging. Medulloblastoma / radiography. Tomography, X-Ray Computed
  • [MeSH-minor] Adolescent. Adult. Aged. Child. Child, Preschool. Female. Humans. Infant. Male. Meninges / pathology. Middle Aged. Neoplasm Invasiveness. Prognosis. Survival Rate

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  • (PMID = 14615567.001).
  • [ISSN] 1527-1323
  • [Journal-full-title] Radiographics : a review publication of the Radiological Society of North America, Inc
  • [ISO-abbreviation] Radiographics
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 102
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38. Yomo S, Tada T, Hirayama S, Tachibana N, Otani M, Tanaka Y, Hongo K: A case report and review of the literature. J Neurooncol; 2007 Jan;81(2):209-16

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  • Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare central nervous system neoplasm in which gliomatous tissue is diffusely identified in the subarachnoid space with no evidence of a primary intraparenchymal tumor.
  • Examinations of cerebrospinal fluid (CSF) did not show malignant cells but increased protein and pleocytosis.
  • Magnetic resonance (MR) imaging demonstrated diffuse leptomeningeal enhancement without any source of intraparenchymal lesion.
  • A biopsy disclosed wide spreading of anaplastic glial cells within the leptomeninges.
  • He died 3 months later because of disease progression despite both radiotherapy and chemotherapy.
  • Reviewing previous cases of PDLG instructs that this entity is rare, resembles meningitis in clinical pictures, usually occurs in a relatively younger population and has more progressive clinical course than the ordinary form of malignant gliomas.

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  • (PMID = 17031563.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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39. Lee IH, Kim ST, Suh YL, Kim HJ, Kim KH, Jeon P, Byun HS: Infratentorial oligodendrogliomas: Imaging findings in six patients. Acta Radiol; 2010 Mar;51(2):213-7
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  • Tumor location, circumscription, signal intensity (SI), enhancement pattern, the presence of restricted diffusion, and the change of the relative cerebral blood volume (rCBV) on MRI were evaluated.
  • Three of them were of the infiltrative type, and the other three of the mass-forming type.
  • Three patients had restricted diffusion, and one had leptomeningeal seeding.
  • Tumor progression after operation, radiation therapy, gamma-knife surgery, or chemotherapy developed in five patients.
  • Infratentorial oligodendrogliomas may be more malignant than supratentorial oligodendrogliomas.

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  • (PMID = 19912073.001).
  • [ISSN] 1600-0455
  • [Journal-full-title] Acta radiologica (Stockholm, Sweden : 1987)
  • [ISO-abbreviation] Acta Radiol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Contrast Media
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40. Nagaishi M, Suzuki R, Tanaka Y, Hoya K, Narita Y, Shinomiya A, Shibui S, Hyodo A: Pure germinoma of the pineal gland with synchronous spinal dissemination--case report. Neurol Med Chir (Tokyo); 2010;50(6):505-8
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  • Craniospinal magnetic resonance imaging showed an enhanced tumor in the pineal gland and widespread leptomeningeal dissemination in the spinal canal.
  • Biopsy of the pineal tumor was performed.
  • Chemotherapy with carboplatin and etoposide in combination with radiotherapy induced complete remission of the tumors.
  • He regained normal eye movement and sensation in his left leg during the chemotherapy period.
  • Germinomas with dissemination are generally more malignant and refractory than solitary germinomas, but this patient showed a strong response to chemoradiotherapy.
  • [MeSH-minor] Child. Humans. Male. Treatment Outcome

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  • (PMID = 20587981.001).
  • [ISSN] 1349-8029
  • [Journal-full-title] Neurologia medico-chirurgica
  • [ISO-abbreviation] Neurol. Med. Chir. (Tokyo)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Japan
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41. Gururangan S, McLaughlin CA, Brashears J, Watral MA, Provenzale J, Coleman RE, Halperin EC, Quinn J, Reardon D, Vredenburgh J, Friedman A, Friedman HS: Incidence and patterns of neuraxis metastases in children with diffuse pontine glioma. J Neurooncol; 2006 Apr;77(2):207-12
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  • Some patients also underwent magnetic resonance spectroscopy (MRS) (6 patients) and fluorodeoxyglucose positron emission tomography (FDG-PET) scans (13 patients) to further evaluate areas of metastatic disease.
  • RESULTS: Between 1986 and 2003, 18 of 96 patients (17.3%) with DPG developed NM.
  • All patients had adjuvant chemotherapy and/or focal radiotherapy at diagnosis.
  • Three patterns of NM were seen on MRI of brain and spine in these patients; 8 (39%) had parenchymal (PM), 4 (22%) leptomeningeal (PM), 2 (11%) subependymal, and in 5 a combination of two or more patterns.
  • The MRS and FDG-PET scan of suspected areas of metastatic disease was consistent with tumor in 6 of 6 and 12 of 13 patients who underwent these procedures respectively.
  • Three patients also had histologic confirmation of malignant glioma at the site of NM.
  • Despite salvage therapy, all 18 patients have died of disease at a median of 5 months (range, 0.5-20) from diagnosis of neuraxis spread.
  • CONCLUSION: Our study emphasizes the need for screening patients with DPG for NM at the time of recurrence.
  • [MeSH-minor] Adolescent. Child. Child, Preschool. Combined Modality Therapy. Female. Fluorodeoxyglucose F18. Humans. Incidence. Magnetic Resonance Imaging. Male. Positron-Emission Tomography. Retrospective Studies. Survival Analysis

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  • (PMID = 16568209.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0Z5B2CJX4D / Fluorodeoxyglucose F18
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42. Oshiro S, Komatsu F, Tsugu H, Nabeshima K, Abe H, Ohkawa M, Inoue T: [A case of intramedullary cervical metastasis from cerebellar anaplastic oligodendroglioma without typical MR appearance for CSF dissemination]. No Shinkei Geka; 2010 Mar;38(3):279-85
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  • We report a case of intramedullary cervical metastasis from cerebellar anaplastic oligodendroglioma without any MR appearance for CSF dissemination or recurrence in the primary tumor site.
  • The case was a 73-year-old female who underwent tumor resection for cerebellar anaplastic oligodendroglioma following irradiation and TMZ chemotherapy.
  • One year and a half later, a small nodular lesion developed at the temporal lobe.
  • While treatment with TMZ was restarted during the course, another intramedullary cervical lesion produced additionally without any CSF dissemination or recurrence at the primary site.
  • The histological examination obtained in spinal surgery revealed evidence of similar features consistent with a previous cerebellar tumor with anaplastic oligodendroglioma.
  • Although CSF dissemination by malignant glioma with leptomeningeal enhancement is relatively well recognized at their terminal stage, cases with intramedullary cervical metastasis without any leptomeningeal enhancement have only been rarely described.
  • We discussed the mechanisms of intramedullary cervical metastasis from intracranial malignant glioma.

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  • (PMID = 20229774.001).
  • [ISSN] 0301-2603
  • [Journal-full-title] No shinkei geka. Neurological surgery
  • [ISO-abbreviation] No Shinkei Geka
  • [Language] jpn
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Japan
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43. Rogers LR: Cerebrovascular complications in cancer patients. Neurol Clin; 2003 Feb;21(1):167-92
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  • [Title] Cerebrovascular complications in cancer patients.
  • Coagulation disorders are common in cancer patients.
  • Cancer treatments may also contribute to this coagulopathy, which usually, but not exclusively, occurs in the setting of advanced malignant disease.
  • The laboratory evidence of coagulopathy is difficult to distinguish from the asymptomatic coagulopathy that often accompanies advanced cancer, and the test results must be interpreted cautiously.
  • There is no established treatment for the thrombotic coagulopathy associated with cancer, but anticoagulation should be considered.
  • Therapy of acute DIC is controversial and should be individualized for the clinical setting.
  • Cerebrovascular disorders can complicate metastatic or primary tumor in the brain, skull, dura, or leptomeninges.
  • The clinical signs of infarction are indistinguishable from other causes of stroke, except that tumor-related venous occlusion will usually first produce signs of increased intracranial pressure.
  • The diagnosis of tumor-related infarction can usually be established by neuroimaging studies that show infarction and may show extracerebral sites of tumor.
  • CSF examination is useful in diagnosing leptomeningeal metastasis.
  • A search for lung or cardiac tumor should be performed when embolic tumor infarction is suspected.
  • Primary or metastatic tumors in the brain or dura may hemorrhage, producing the initial clinical signs of the brain tumor or a change in chronic signs induced by the tumor.
  • The brain hemorrhage may require evacuation and the underlying tumor will usually require additional antineoplastic treatment.
  • Cerebral arterial or venous thrombosis is sometimes the result of cancer therapy.
  • The attribution of thrombosis to chemotherapy in many published cases is only speculative, because carefully conducted prospective studies that include investigation for other thrombotic causes are not available.
  • The best-known associations with thrombosis are L-asparaginase, which is typically used in the induction therapy of acute lymphocytic leukemia, and combination hormonal therapy and chemotherapy for breast cancer.
  • Small clinical series suggest that surgical treatment is equally effective as in nonirradiated carotid atherosclerosis.
  • Brain hemorrhages can result from chemotherapy effects on the hemostatic system or a microangiopathic anemia.
  • Opportunistic infections, especially fungal infections, can complicate cancer or its treatment.
  • A clinician can usually establish the cause of stroke in the cancer patient by performing a careful review of the clinical setting--including the type and extent of cancer and the type of antineoplastic therapy--in which the stroke occurred.
  • Therapy may ameliorate symptoms or prevent further episodes.
  • The identification of one of these unusual stroke syndromes that leads to the diagnosis of an occult and treatable cancer can be particularly rewarding.

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  • (PMID = 12690649.001).
  • [ISSN] 0733-8619
  • [Journal-full-title] Neurologic clinics
  • [ISO-abbreviation] Neurol Clin
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 87
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44. Jahraus CD, Dishop MK, Bayliff SL, Lee C, St Clair WH: Atypical presentation and progression of glioblastoma multiforme in a 6-year-old girl: multidisciplinary case report. J Pediatr Hematol Oncol; 2003 Mar;25(3):243-7
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  • Glioblastoma multiforme is the most common adult malignant brain tumor but is notably less common in children.
  • The authors describe the case of a child who presented for evaluation and treatment of neurologic signs caused by a brain stem glioma.
  • Response to radiotherapy and chemotherapy with temozolomide was initially positive, but later extensive leptomeningeal metastasis developed.

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  • (PMID = 12621245.001).
  • [ISSN] 1077-4114
  • [Journal-full-title] Journal of pediatric hematology/oncology
  • [ISO-abbreviation] J. Pediatr. Hematol. Oncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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