Neurology (General Neurology)

Background: Leptomeningeal Carcinomatosis (LMC) is defined as a diffuse or multifocal malignant infiltration of the Pia matter and arachnoid membrane. It is clinically diagnosed in 5-10% of all cancer patients. The most commonly reported cancers associated with LMC are breast, lung and hematological malignancies. Patients with LMC commonly present with multifocal neurological symptoms. Symptoms are related to increase intracranial pressure, hemispheric dysfunction, cranial neuropathies and spinal roots dysfunction. We report a case of LMC secondary to Gastroesophageal junction cancer present initially with Cauda equine syndrome. Methods: A 51 year old male patient with adenocarcinoma of Gastroesophageal junction who underwent surgical resection, chemotherapy and radiation therapy. Nine month after diagnosis he presented with left leg pain, mild weakness and saddle area numbness. Initial radiological examination were unremarkable. Subsequently he had worsening of his leg weakness, fecal incontinence and urine retention. Two days later he developed rapidly progressive cranial neuropathies including facial diplegia, sensorineural hearing loss, dysarthria and dysphagia. Results: MRI with and without contrast showed diffuse enhancement of leptomeninges surrounding the brain, spinal cord and Cauda equine extending to the nerve roots. Cerebrospinal fluid cytology was positive for malignant cells. Conclusion: In cancer patient with Cauda equina syndrome and absence of structural lesion on imaging, LMC should be considered.

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Cauda Equina Syndrome Secondary to Leptomeningeal Carcinomatosis of Gastroesophageal Junction Cancer

Case Reports in Neurology ◽

10.1159/000445869 ◽

2016 ◽

Vol 8 (1) ◽

pp. 87-91 ◽

Cited By ~ 2

Author(s):

Amal Alkhotani ◽

Nouf Alrishi ◽

M. Salem Alhalabi ◽

Tahira Hamid

Keyword(s):

Cauda Equina Syndrome ◽

Gastroesophageal Junction ◽

Cauda Equina ◽

Leptomeningeal Carcinomatosis ◽

Leg Pain ◽

Urine Retention ◽

Gastroesophageal Junction Cancer ◽

First Case ◽

Facial Diplegia ◽

Leg Weakness

Leptomeningeal carcinomatosis (LMC) is a diffuse or multifocal malignant infiltration of the pia matter and arachnoid membrane. The most commonly reported cancers associated with LMC are breast, lung, and hematological malignancies. Patients with LMC commonly present with multifocal neurological symptoms. We report a case of LMC secondary to gastroesophageal junction cancer present initially with cauda equina syndrome. A 51-year-old male patient with treated adenocarcinoma of the gastroesophageal junction presented with left leg pain, mild weakness, and saddle area numbness. Initial radiological examinations were unremarkable. Subsequently, he had worsening of his leg weakness, fecal incontinence, and urine retention. Two days later, he developed rapidly progressive cranial neuropathies including facial diplegia, sensorineural hearing loss, dysarthria, and dysphagia. MRI with and without contrast showed diffuse enhancement of leptomeninges surrounding the brain, spinal cord, and cauda equina extending to the nerve roots. Cerebrospinal fluid cytology was positive for malignant cells. The patient died within 10 days from the second presentation. In cancer patients with cauda equina syndrome and absence of structural lesion on imaging, LMC should be considered. To our knowledge, this is the first case of LMC secondary to gastroesophageal cancer presenting with cauda equina syndrome.

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1499 The Statistical Value of Different Clinical Characteristics in Evaluation of Suspected Cauda Equina Syndrome

British Journal of Surgery ◽

10.1093/bjs/znab259.1058 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

W Levitt ◽

B Kamalakannan ◽

Y Leung

Keyword(s):

Back Pain ◽

Cauda Equina Syndrome ◽

Pain Sensitivity ◽

Cauda Equina ◽

Leg Pain ◽

Statistical Association ◽

Mri Findings ◽

Leg Weakness ◽

Red Flag ◽

One Year

Abstract Introduction Cauda Equina Syndrome(CES) is a potentially disabling condition caused by compression of the thecal sac in the lumbar spine. Traditional teaching suggests red flags include back pain, sciatica, saddle anaesthesia and bladder disturbance. Current guidelines from the British Association of Spinal Surgeons recommend prompt investigation with MRI should these symptoms be present. Method A retrospective electronic case note review was undertaken from a one-year period to identify patients referred to the on call orthopaedic team with suspected CES and were investigated with MRI. Notes were reviewed for the presence of each clinical characteristic and correlated with MRI findings. Results 334 referrals underwent urgent MRI with 25 scans showing CES. Poor statistical association was observed with unilateral leg pain (sensitivity 0.28, specificity 0.48), back pain (sensitivity 0.92, specificity 0.13) and bladder dysfunction (sensitivity 0.72, specificity 0.36). Much closer statistical association was seen with bilateral leg pain (sensitivity 0.6, specificity 0.7, OR 5.03, 95% CI 2.16-11.68, p0.0002), leg weakness (sensitivity 0.68, specificity of 0.72, OR 5.35, 95% CI 2.23-12.85, p0.0002), leg sensory deficit (sensitivity 0.72, specificity 0.60, OR 3.79, 95% CI 1.54-9.36, p0.004) and altered perianal sensation (sensitivity 0.6, specificity 0.67, OR 3.03, 95% CI 1.31-6.99, p 0.009) Conclusions The diagnostic accuracy for some conventional red flag characteristics in CES is low. In our series back pain, unilateral sciatica and bladder disturbance showed low predictive value while bilateral sciatica, saddle anesthesia and lower limb sensorimotor deficits showed closer association and therefore should be closely evaluated for when reviewing such patients.

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A Study of Niraparib Combined With MGD013 in Gastric/Gastroesophageal Junction Cancer

Case Medical Research ◽

10.31525/ct1-nct04178460 ◽

2019 ◽

Author(s):

Keyword(s):

Gastroesophageal Junction ◽

Gastroesophageal Junction Cancer

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Emerging Targeted Therapies for HER2 Positive Gastric Cancer That Can Overcome Trastuzumab Resistance

Cancers ◽

10.3390/cancers12020400 ◽

2020 ◽

Vol 12 (2) ◽

pp. 400 ◽

Cited By ~ 5

Author(s):

Seiichiro Mitani ◽

Hisato Kawakami

Keyword(s):

Gastroesophageal Junction ◽

Treatment Strategies ◽

Growth Factor Receptor ◽

Trastuzumab Resistance ◽

Her2 Positive ◽

Drug Conjugates ◽

Gastroesophageal Junction Cancer ◽

Development Of Resistance ◽

Epidermal Growth ◽

Antibody Drug

Trastuzumab, a monoclonal antibody to human epidermal growth factor receptor 2 (HER2), has improved survival in patients with HER2-positive advanced gastric or gastroesophageal junction cancer (AGC). The inevitable development of resistance to trastuzumab remains a problem, however, with several treatment strategies that have proven effective in breast cancer having failed to show clinical benefit in AGC. In this review, we summarize the mechanisms underlying resistance to HER2-targeted therapy and outline past and current challenges in the treatment of HER2-positive AGC refractory to trastuzumab. We further describe novel agents such as HER2 antibody–drug conjugates that are under development and have shown promising antitumor activity in early studies.

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