Unexpected infiltration of meninges by generalised diffuse large B-cell lymphoma manifesting as multiple cranial neuropathies in a patient with history of breast carcinoma
Abstract
Leptomeningeal spread of malignant tumorous cells occurs more commonly in haematological malignancies (incidence of 10-15%) and less often with solid tumours such as breast cancer, lung cancer, and melanoma (incidence of 1-5%) [1]. Diagnostic methods mainly include clinical assessment, cerebrospinal fluid cytological examinations [2], and magnetic resonance imaging (MRI) to distinguish brain metastases from other brain tumours [3].
We present a case of leptomeningeal malignant infiltration in a patient with known breast carcinoma, that initially presented as multiple cranial neuropathies. Surprisingly, but consistent with previous cerebrospinal fluid (CSF) examinations, the autopsy excluded meningeal carcinomatosis by breast cancer malignant cells, and confirmed generalised B-cell lymphoma, including leptomeningeal infiltration.
An 84-year-old female with a history of diabetes, arterial hypertension, and breast cancer diagnosed three years previously and treated by mastectomy and tamoxifen, presented with multiple cranial nerve palsies.