Leptomeningeal Metastasis from Colorectal Cancer Treated with Folinic Acid, Fluorouracil, and Oxaliplatin Chemotherapy Plus Bevacizumab: A Case Report.
Tomohiro Hayakawa, Yoshiharu Nakamura, Hiroki Masuda et al.
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Case in brief
A 63-year-old man receiving bevacizumab-containing chemotherapy for colorectal cancer was admitted with loss of appetite and frequent episodes of loss of consciousness. Imaging showed no abnormality to explain his symptoms, but cerebrospinal fluid cytology confirmed leptomeningeal metastasis. His symptoms worsened, impairing communication and preventing further chemotherapy. He died 3 weeks after admission.
What made this case unusual
Leptomeningeal metastasis was identified by cerebrospinal fluid cytology despite unrevealing imaging in a patient with colorectal cancer.
Diagnostic / clinical pearl
In a patient with cancer and central nervous system symptoms, normal imaging does not exclude leptomeningeal metastasis; cerebrospinal fluid cytology can establish the diagnosis.