Uncommon presentation of leptomeningeal carcinomatosis from gastric cancer: a case report

: Leptomeningeal carcinomatosis in gastric adenocarcinoma is very rare (0.16–0.69%). Breast cancer, lung cancer, melanoma and hematologic malignancies are the most common causes of leptomeningeal carcinomatosis. The diagnosis is usually established by the presence of malignant cells in cerebrospinal fluid along with magnetic resonance imaging. There are few published studies about this condition and prognosis is very poor. We present a case of a 67-year-old man with a localized gastric cancer adenocarcinoma treated with perioperative chemotherapy and total gastrectomy with D2 lymphadenectomy. During the post treatment surveillance, recurrence occurred after a year, with exclusive leptomeningeal location. Clinical presentation consisted of bilateral optic peri neuritis, a peculiar manifestation which required an extensive differential diagnosis including inflammatory, infectious, autoimmune diseases, genetic and toxic neuropathies. Treatment strategy of this condition is not established. Besides symptomatic therapy, chemotherapy or radiotherapy are treatment options, even though these are palliative treatments and results are disappointing. This patient died 3 months after diagnosis of leptomeningeal involvement. We underline the rarity of this condition, the need for a high level of clinical suspicion and the difficulty in the diagnostic and treatment process. Late diagnosis and shortage of prospective randomized trials may be the reason for poor prognosis. Further studies are needed to better improve gastric leptomeningeal carcinomatosis treatment.