Neurological Surgery No Shinkei Geka Volume 43, Issue 9 (September 2015)

Radiotherapy for Alleviation of Paraparesis due to Leptomeningeal and Cauda Equina Metastasis of HER2-Positive Breast Cancer:A Case Report Shutaro FUJIMOTO 1,5 , Motoyuki IWASAKI 1 , Masaki ITO 1 , Yoshimasa NIIYA 1 , Hiroyuki ITOSAKA 1 , Shouji MABUCHI 1 , Takeshi NISHIOKA 2 , Hayato ECHIZENYA 3 , Kiyoshi KASAI 4 1Department of Neurosurgery, Otaru General Hospital 2Department of Radiology, Otaru General Hospital 3Department of Surgery, Otaru General Hospital 4Department of Pathology, Otaru General Hospital 5Postgraduate Clinical Training Center, Otaru General Hospital Keyword: leptomeningeal metastasis , cauda equina metastasis , breast cancer , radiotherapy , HER2-positive pp.819-823
Published Date 2015/9/10
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 Leptomeningeal metastasis is a rare entity and its diagnosis is often difficult. Moreover, evidence-based therapeutic strategies have not yet been established. A 52-year-old woman presented with high fever and was diagnosed with bacterial meningitis at first examination;although her fever was alleviated, she experienced motor weakness in both of her lower extremities. Ga scintigraphy highlighted the hot-spot areas of the disease in the cranial bone. She was then transferred to our department. Open biopsy of the skull showed metastasis of the cancer. Chest CT results indicated right breast cancer and Gd-DTPA imaging showed obvious enhancement of the pia mater around the conus medullaris and cauda equina.

 However, cerebrospinal fluid(CSF)cytological examination did not show the presence of any positive cells;consequently, mastectomy was performed in the thoracic surgical department. The severity of paraparesis and pain in her legs increased;however, repeat MRI 1 month later showed no evidence of any change. Therefore, we performed biopsy of the cauda equina and arachnoid lesions. The pathological diagnosis was metastasis of breast cancer with positive human epidermal growth factor receptor 2(HER2)immunological staining. The results of a repeat cytological examination of the CSF during the surgery were negative. Local radiotherapy(25 Gy/5 Fr)as a monotherapy was selected for the patient, because her family did not approve of the combination of radiotherapy and chemotherapy. The severity of both paraparesis and limb pain decreased immediately after the radiotherapy.

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Neurological Surgery 脳神経外科
43巻9号 (2015年9月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院