Leptomeningeal carcinomatosis and cranial nerve palsy as presenting symptoms of a clinically inapparent gallbladder carcinoma

We present an occult metastatic signet-ring cell gallbladder carcinoma in a 78-year-old woman, who complained of recurrent headaches, dysarthria, and paresis of the tongue. Cranial imaging showed contrast enhancement of the b asal leptomeninges, and the cerebrospinal fluid displayed clusters of adeno carcinoma cells proposed as leptomeningeal carcinomatosis of the breast, lu ng or gut. However, postmortem examination revealed the gallbladder as the site of the primary carcinoma with focal signet-ring cell differentiation. In patients with progressive neurologic deterioration due to leptomeningeal carcinomatosis, adenocarcinomas from the gastrointestinal and hepatic syst ems should be considered. It is likely that signet-ring cell carcinomas dis play an increased affinity to leptomeningeal spread.