LEPTOMENINGEAL CARCINOMATOSIS - A SEQUELA OF CHOLANGIOCARCINOMA

Leptomeningeal carcinomatosis is a rare and deceptive presentation of systemic cancer. We report the treatment of a patient with a Klatskin' s tumor by surgical resection. The patient presented with symptoms sug gestive of liver failure in the early postoperative period. He rapidly developed progressive, multineuroaxis symptoms and died. Routine gast rointestinal evaluation failed to demonstrate any intraabdominal patho logic process that could be responsible for his decline. A MRI of the brain was also unremarkable. Serial lumbar punctures, however, documen ted leptomeningeal carcinomatosis consistent with a gastrointestinal p rimary. The clinical presentation of leptomeningeal carcinomatosis is subtle and may masquerade as another disease state. The hallmark of th is lethal process is the finding of progressive neurologic deficits at more than one level of the neuroaxis. Serial cerebrospinal fluid exam ination is often diagnostic. This is the first known report of leptome ningeal carcinomatosis secondary to primary cholangiocarcinoma.