Carcinomatose das meninges: dados clínico-patológicos de 3 casos

Queiroz, Aristides Cheto de; Melo, Carlos Renato

doi:10.1590/S0004-282X1974000400004

Resumos

Foram estudados 3 casos de carcinomatose das meninges, autopsiados no serviço de Anatomia Patológica do Hospital Prof. Edgard Santos. O quadro neurológico apresentado era proeminente e representado por sinto- matologia decorrente do envolvimento meníngeo e encefálico, razão pela qual foram considerados como portadores de meningite tuberculosa e encefalomielite. O aspecto de maior interesse neste estudo foi a discrepância entre o quadro clínico e os dados anátomo-patológicos do exame do encéfalo. A sintomatologia clínica foi proeminente, enquanto as lesões anatômicas foram apenas discretas ou moderadas e representadas por espessamento e granulosidade das meninges, com infiltração difusa do espaço subaracnoideano pela neoplasia. Nos casos 1 e 3 a neoplasia estava representada por adenocarcinoma, cujos focos primitivos foram localizados no pulmão e vesícula biliar, respectivamente. O caso 2 era um carcinoma indiferenciado do estômago, com envolvimento difuso do espaço subaracnoideano e subdural, havendo neste último extensa hemorragia recente. Os critérios diagnósticos e a maneira de disseminação desta condição são discutidos.

A diffuse involvement of the meninges by carcinoma is described in three cases characterizing the so called "meningeal carcinomatosis". The neurologic symptoms were those of the chronic meningitis or encephalomyelitis, with changes in the spinal fluid. The morphologic features were identical in the three cases and represented by slight to moderate thickening of the meninges by diffuse infiltration of tumor cells and few foci of inflamatory reaction. The cases 1 and 3 were represented by well differentiated adenocarcinoma with primary site in the lung and gallbladder, respectively. In case 2 the tumor was a poorly differentiated carcinoma of stomach with diffuse involvement of the arachnoid and dura mater associated with recent hemorrhage. An interesting point was the lack of correlation between clinical and pathological findings. The clinical symptoms were very prominent and the gross findings only slight to moderate. The criteria for diagnosis of this entity as well as the mechanism of dissemination of the carcinoma to the meninges are reviewed and discussed.

Carcinomatose das meninges. Dados clínico-patológicos de 3 casos

Carcinomatosis of the meninges: a report of three cases

Aristides Cheto de Queiroz^I; Carlos Renato Melo^II

^IServiço de Anatomia Patológica do Hosp. Prof. Edgard Santos, Salvador BA: Prof. Assistente do Departamento de Patologia Aplicada e Medicina Legal (setor Patologia Aplicada), da Faculdade de Medicina da Universidade da Bahia

^IIServiço de Anatomia Patológica do Hosp. Prof. Edgard Santos, Salvador BA: Mestrando em Patologia Humana. Bolsista da CAPES

RESUMO

Foram estudados 3 casos de carcinomatose das meninges, autopsiados no serviço de Anatomia Patológica do Hospital Prof. Edgard Santos. O quadro neurológico apresentado era proeminente e representado por sinto- matologia decorrente do envolvimento meníngeo e encefálico, razão pela qual foram considerados como portadores de meningite tuberculosa e encefalomielite. O aspecto de maior interesse neste estudo foi a discrepância entre o quadro clínico e os dados anátomo-patológicos do exame do encéfalo. A sintomatologia clínica foi proeminente, enquanto as lesões anatômicas foram apenas discretas ou moderadas e representadas por espessamento e granulosidade das meninges, com infiltração difusa do espaço subaracnoideano pela neoplasia. Nos casos 1 e 3 a neoplasia estava representada por adenocarcinoma, cujos focos primitivos foram localizados no pulmão e vesícula biliar, respectivamente. O caso 2 era um carcinoma indiferenciado do estômago, com envolvimento difuso do espaço subaracnoideano e subdural, havendo neste último extensa hemorragia recente. Os critérios diagnósticos e a maneira de disseminação desta condição são discutidos.

SUMMARY

A diffuse involvement of the meninges by carcinoma is described in three cases characterizing the so called "meningeal carcinomatosis". The neurologic symptoms were those of the chronic meningitis or encephalomyelitis, with changes in the spinal fluid. The morphologic features were identical in the three cases and represented by slight to moderate thickening of the meninges by diffuse infiltration of tumor cells and few foci of inflamatory reaction. The cases 1 and 3 were represented by well differentiated adenocarcinoma with primary site in the lung and gallbladder, respectively. In case 2 the tumor was a poorly differentiated carcinoma of stomach with diffuse involvement of the arachnoid and dura mater associated with recent hemorrhage. An interesting point was the lack of correlation between clinical and pathological findings. The clinical symptoms were very prominent and the gross findings only slight to moderate. The criteria for diagnosis of this entity as well as the mechanism of dissemination of the carcinoma to the meninges are reviewed and discussed.

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Hospital Prof. Edgar Santos Faculdade de Medicina, Universidade Federal da Bahia Serviço de Anatomia Patológica 40000 Salvador BA Brasil.

1. ALAJOUANINE, T.; BOUDIN, G. & CONTAMIN, J. N. Polyradiculonéurite généralisée rapidement mortelle; méningite cancéreuse et infiltration directe des racines au contact des méninges malades. Rev. Neurol. (Paris) 82:40, 1950.
2. BERG, L. Central nervous system disease characterized by low spinal fluid sugar. Amer. J. Medicine 20:275, 1956.
3. BRAUN, E. M.; BURGER, L. J. & SCHLANG, H. A. Subdural hematoma from metastatic malignant disease. Cancer 32:1370, 1973.
4. BRUCHER, J. M. & CERVOS-NAVARRO, J. La carcinomatose méningée. Etude anatomoclinique de 11 cas. Acta Neurol. et Psychiat. Belgica 60:368, 1960.
5. CRUZ, O. R. Carcinomatose das meninges. Arq. Neuro-Psiquiat. (São Paulo) 17:61, 1959.
6. DAUM, S. & FOULIN, J. F. Les tumeurs diffuses des leptomeninges. Rev. Neurol. (Paris) 108:597, 1963.
7. DODGE, H. W.; SVIEN, h. J. & SAYRE, G. P. Cerebrospinal fluid in diffuse neoplastic involvement of the meninges. Proc. Staff Meetings Mayo Clinic 27:259, 1952.
8. FISCHER-WILLIAMS, M.; BOSANQUET, F. D. & DANIEL, P. M. Carcinomatosis of the meninges: a report of three cases. Brain 78:42, 1955.
9. GOLDING, D. N. Secondary adenocarcinoma of the meninges presenting with pain in the back. British J. Clinical Practice 23:299, 1969.
10. MADQW, L. & ALPERS, B. J. Encephalitic form of metastatic carcinoma. Arch. Neurol. Psychiat. (Chicago) 65:161, 1951.
11. MEISSNER, G. F. Carcinoma of the stomach with meningeal carcinosis. Report of four cases. Cancer 6:313, 1953.
12. PLAUT, A. Diffuse spinal-meningeal metastases from paranasal carcinoma. J. Neuropathology Exper. Neurol. 13:385, 1954.
13. REBUCCI, G. G. & COCCAGNA, G. La carcinomatosi meningea. A proposito di 4 osservazioni anatomo-cliniche. Giornale di Psichiat. Neuropatol. 90:409, 1963.
14. ROGERS, D. E. & McDERMOTT, W. Neoplastic involvement of the meninges with low cerebrospinal fluid glucose concentrations simulating tuberculous meningitis. Amer. Rev. Tuberculosis 69:1029, 1954.
15. RUSSEL, D. S. & CAIRNS, h. Subdural false membrane or haematoma (pachymeningitis interna haemorrhagica) in carcinomatosis and sarcomatosis of the dura mater. Brain 57:32, 1934.
16. SIGWALD, J.; AJURIAGUERRA, J.; BOUTTIER, D. & MLLE. HÉBERT Meningite carcinomateuse secondaire a un cancer du sein. Rev. Neurol. (Paris) 96:286, 1957.
17. VITAL, C.; BRUNO-MARTIN, F.; HENRY P.; BERGOUIGNAN, M. & LÉGER, H. La carcinomatose méningée. Bordeaux Méd. 3:2927, 1970.

Datas de Publicação

Publicação nesta coleção
09 Abr 2013
Data do Fascículo
Dez 1974

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ALAJOUANINE, T.; BOUDIN, G. & CONTAMIN, J. N. Polyradiculonéurite généralisée rapidement mortelle; méningite cancéreuse et infiltration directe des racines au contact des méninges malades. Rev. Neurol. (Paris) 82:40, 1950.

[2] 2. BERG, L. Central nervous system disease characterized by low spinal fluid sugar. Amer. J. Medicine 20:275, 1956.

[3] 3. BRAUN, E. M.; BURGER, L. J. & SCHLANG, H. A. Subdural hematoma from metastatic malignant disease. Cancer 32:1370, 1973.

[4] 4. BRUCHER, J. M. & CERVOS-NAVARRO, J. La carcinomatose méningée. Etude anatomoclinique de 11 cas. Acta Neurol. et Psychiat. Belgica 60:368, 1960.

[5] 5. CRUZ, O. R. Carcinomatose das meninges. Arq. Neuro-Psiquiat. (São Paulo) 17:61, 1959.

[6] 6. DAUM, S. & FOULIN, J. F. Les tumeurs diffuses des leptomeninges. Rev. Neurol. (Paris) 108:597, 1963.

[7] 7. DODGE, H. W.; SVIEN, h. J. & SAYRE, G. P. Cerebrospinal fluid in diffuse neoplastic involvement of the meninges. Proc. Staff Meetings Mayo Clinic 27:259, 1952.

[8] 8. FISCHER-WILLIAMS, M.; BOSANQUET, F. D. & DANIEL, P. M. Carcinomatosis of the meninges: a report of three cases. Brain 78:42, 1955.

[9] 9. GOLDING, D. N. Secondary adenocarcinoma of the meninges presenting with pain in the back. British J. Clinical Practice 23:299, 1969.

[10] 10. MADQW, L. & ALPERS, B. J. Encephalitic form of metastatic carcinoma. Arch. Neurol. Psychiat. (Chicago) 65:161, 1951.

[11] 11. MEISSNER, G. F. Carcinoma of the stomach with meningeal carcinosis. Report of four cases. Cancer 6:313, 1953.

[12] 12. PLAUT, A. Diffuse spinal-meningeal metastases from paranasal carcinoma. J. Neuropathology Exper. Neurol. 13:385, 1954.

[13] 13. REBUCCI, G. G. & COCCAGNA, G. La carcinomatosi meningea. A proposito di 4 osservazioni anatomo-cliniche. Giornale di Psichiat. Neuropatol. 90:409, 1963.

[14] 14. ROGERS, D. E. & McDERMOTT, W. Neoplastic involvement of the meninges with low cerebrospinal fluid glucose concentrations simulating tuberculous meningitis. Amer. Rev. Tuberculosis 69:1029, 1954.

[15] 15. RUSSEL, D. S. & CAIRNS, h. Subdural false membrane or haematoma (pachymeningitis interna haemorrhagica) in carcinomatosis and sarcomatosis of the dura mater. Brain 57:32, 1934.

[16] 16. SIGWALD, J.; AJURIAGUERRA, J.; BOUTTIER, D. & MLLE. HÉBERT Meningite carcinomateuse secondaire a un cancer du sein. Rev. Neurol. (Paris) 96:286, 1957.

[17] 17. VITAL, C.; BRUNO-MARTIN, F.; HENRY P.; BERGOUIGNAN, M. & LÉGER, H. La carcinomatose méningée. Bordeaux Méd. 3:2927, 1970.