Gastric linitis adenocarcinoma and carcinomatous meningitis: An infrequentbut aggressive association - report of four cases

Carcinomatous meningitis (CM) is a very rare complication of gastrointestin al malignancies and especially gastric adenocarcinoma. Linitis plastica (LP ), which is a specific form of gastric neoplasia, locally penetrates throug h the gastric wall to reach the peritoneum. Lymph node involvement is frequ ent and metastatic sites are almost exclusively observed in the abdominal c avity. The meningeal localization is extremely rare with only a few cases d escribed in the literature. We report here, over a five-year period, four c ases of CM on a total of eighty linitis cases diagnosed and treated in our institution, which represent 5% of a non selected linitis population. The c linical manifestations were clearly poor, and characterized by aspecific ne urological signs. The diagnosis was made by the discovery of signet cells i n the cerebrospinal fluid. Invasive treatment, consisting of intrathecal in fusion of chemotherapy, was undertaken with mixed clinical response and no cytological normalization of the cerebrospinal fluid (CSF). In conclusion, our observation which is based on a large series of successive gastric lini tis, demonstrates a 5% frequency of developing CM with a predominance among metastatic patients. Furthermore, the diagnosis of CM must be done as soon as possible because of the clear effectiveness of a therapeutic approach o n the improvement of symptoms and quality of life.