MENINGEAL CARCINOMATOSIS FROM TRANSITIONAL-CELL CARCINOMA OF THE BLADDER

Response rates of over 50% can be achieved in patients with metastatic transitional cell carcinoma of the bladder treated with cisplatin-bas ed chemotherapy. With prolonged survival, intraparenchymal brain metas tases may occur in as many as 12% of patients who received methotrexat e, vinblastine, doxorubicin, and cisplatin (M-VAC) chemotherapy. Menin geal carcinomatosis from urothelial cancer is rare, however. A 71-year -old man, with metastatic, transitional cell carcinoma of the bladder, attained an excellent partial response to M-VAC chemotherapy. He subs equently presented with an acute confusional state 6 months after diag nosis. Head computed tomographic studies were nondiagnostic. Gadoliniu m-enhanced magnetic resonance images (MRI), however, demonstrated mult ifocal 1-cm nodules in the brain parenchyma and enhancement of the men inges. Meningeal carcinomatosis was confirmed by lumbar puncture. Reco rds of 40 patients with advanced transitional cell carcinoma of the bl adder treated with chemotherapy between 1977 and 1992 at a cancer cent er were reviewed retrospectively for the occurrence of documented meni ngeal carcinomatosis, intraparenchymal brain metastases, or both. Amon g 13 responders, only 1 other patient, a 64-year-old man, was identifi ed who had minimal metastatic disease and attained a complete response to methotrexate and cisplatin. The patient relapsed 2 years after res ponse, with cerebellar metastases and meningeal carcinomatosis. Centra l nervous system (CNS) metastases in patients with transitional cell c arcinoma of the bladder are unusual. Although parenchymal brain metast ases may be more common after prolonged remissions induced by combinat ion chemotherapy, meningeal carcinomatosis remains uncommon. MRI may b e a useful adjunct in the diagnosis of CNS metastases. A high index of clinical suspicion for the occurrence of CNS metastases from transiti onal cell carcinoma is encouraged.