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Leptomeningeal Masses or Masquerades: A Spectrum of Diseases with Leptomeningeal Enhancement and their Mimics.
Curr Med Imaging
January 2025
Department of Radiology, Sengkang General Hospital, Singapore.
Background: Leptomeningeal enhancement, visible on MRI, can indicate a variety of diseases, both neoplastic and non-neoplastic.
Objective: This comprehensive pictorial review aims to equip radiologists and trainees with a thorough understanding of the diverse imaging presentations of leptomeningeal disease.
Methods: Drawing from a retrospective analysis of MRI scans conducted between 1 January 2008 and 30 September 2022, at two tertiary teaching hospitals in Singapore, this review covers a wide range of conditions.
Intrathecal pemetrexed for leptomeningeal metastases in a patient with ALK-rearranged lung adenocarcinoma: a case report.
Cancer Chemother Pharmacol
December 2024
Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, USA.
Progressive leptomeningeal metastases (LM) are associated with intractable neurological symptoms and a poor prognosis, and effective treatment options are limited. Intrathecal (IT) pemetrexed has been shown to confer clinical benefit in lung adenocarcinoma, yet our understanding of the efficacy and safety of the treatment is limited. We report a patient with a long-standing history of leptomeningeal disease due to ALK-positive adenocarcinoma of the lung, previously controlled by increased doses of lorlatinib (125 mg/day).
View Article and Find Full Text PDFCase report: Two cases of leptomeningeal metastases in patients with metastatic urothelial carcinoma treated with enfortumab vedotin.
Front Oncol
November 2024
Department of Medicine, Medical Oncology Division, British Columbia (BC) Cancer, Vancouver Centre, University of British Columbia, Vancouver, BC, Canada.
Article Synopsis
- Leptomeningeal carcinomatosis is a rare metastatic pattern in genitourinary cancer, found in less than 0.1% of cases, and can occur even after initial treatments with enfortumab vedotin (EV).
- Two cases of metastatic urothelial cancer are presented: both patients initially showed positive responses to EV but later developed severe neurologic symptoms due to leptomeningeal metastases confirmed through imaging and cytology.
- The cases highlight an unusual progression pattern among patients treated with EV, suggesting the need for further investigation into this type of cancer spread.
Clinical Utility of a Circulating Tumor Cell-Based Cerebrospinal Fluid Assay in the Diagnosis and Molecular Analysis of Leptomeningeal Disease in Patients With Advanced Non-Small Cell Lung Cancer.
JCO Precis Oncol
December 2024
Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA.
Purpose: Leptomeningeal disease (LMD) is associated with significant morbidity and mortality for metastatic non-small cell lung cancer (NSCLC). We describe our clinical experience in evaluating the use of cerebrospinal fluid (CSF)-derived circulating tumor cells (CTCs) for the diagnosis of LMD and the detection of genomic alterations in CSF cell-free DNA (cfDNA).
Methods: Patients with NSCLC who had CSF collection as part of routine clinical care for suspected LMD were included in the study.
Leptomeningeal metastatic disease: new frontiers and future directions.
Nat Rev Clin Oncol
December 2024
Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Leptomeningeal metastatic disease (LMD), encompassing entities of 'meningeal carcinomatosis', neoplastic meningitis' and 'leukaemic/lymphomatous meningitis', arises secondary to the metastatic dissemination of cancer cells from extracranial and certain intracranial malignancies into the leptomeninges and cerebrospinal fluid. The clinical burden of LMD has been increasing secondary to more sensitive diagnostics, aggressive local therapies for discrete brain metastases, and improved management of extracranial disease with targeted and immunotherapeutic agents, resulting in improved survival. However, owing to drug delivery challenges and the unique microenvironment of LMD, novel therapies against systemic disease have not yet translated into improved outcomes for these patients.
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