Méningite Carcinomateuse Révélant des Métastases d’une Tumeur de Vessie

Adama Seydou Sissoko, I Konaté, T Sissoko, T Coulibaly, SH Diallo, M Ziguimé, M Sacko, Y Keïta, Y Maïga, CO Guinto

Abstract


RÉSUMÉ
La méningite carcinomateuse ou carcinomatose letpto-méningée est l’envahissement des espaces lepto-méningés par des cellules tumorales (primitives ou secondaires) avec possibilité de passage dans le LCR. Elle correspond à une évolution tardive et grave qui apparait chez 5 à 10% des patients atteints de cancers. La présentation clinique de la méningite carcinomateuse est très polymorphe associant des signes neurologiques relevant de différentes aires du système nerveux (céphalées, atteinte de nerfs crâniens, troubles des fonctions supérieures, raideur cervicale, troubles de la marche, nausées et ou vomissements …). Le diagnostic de certitude repose essentiellement sur l’examen cytologique du LCR qui met évidence la présence de cellules avec anaplasie nucléaire confirmant le caractère malin de la méningite. Les nouvelles techniques d’imageries cérébrales de plus en plus performantes (IRM, TDM) peuvent objectiver des signes contributifs, mais elles peuvent être prises à défaut dans d’authentiques méningites carcinomateuses (faux négatifs). La prise en charge est fonction du type de tumeurs et de la sévérité de la maladie. Le schéma thérapeutique associe une radiothérapie et une chimiothérapie intra-thécale. Nous rapportons une observation de méningite carcinomateuse chez un patient ayant fait un bref passage en neurologie du CHU du Point G avec une revue de la littérature pour attirer l’attention des praticiens sur cette forme clinique particulière de méningite très souvent sous diagnostiquée.

ABSTRACT
Carcinomatous meningitis or carcinomatosis letptomeningeal is the invasion of lepto-meningeal spaces by tumor cells (primitive or secondary) with possibility of passage in the CSF. It corresponds to a late and serious development that occurs in 5 to 10% of cancer patients. The clinical presentation of carcinomatous meningitis is highly polymorphic, associating neurological signs from different areas of the nervous system (headaches, cranial nerve involvement, disorders of superior functions, cervical stiffness, gait disturbances, nausea and / or vomiting ...). The certainty diagnosis is essentially based on the cytological examination of the CSF which shows the presence of cells with nuclear anaplasia confirming the malignant nature of meningitis. The new techniques of increasingly efficient brain imaging (MRI, CT) can objectify contributing signs, but they can be taken failing in authentic carcinomatous meningitis (false negatives). The management depends on the type of tumors and the severity of the disease. The treatment regimen consists of radiotherapy and intra-thecal chemotherapy. We report a case of carcinomatous meningitis in a patient who had a brief neurology in the Point G UHC with a review of the literature to draw the attention of practitioners to this particular clinical form of meningitis very often under diagnosed.

Keywords


Méningite, Carcinomateuse, Afrique subsaharienne, Mali

Full Text:

PDF (Français)

References


- Kuiper JL, Hendriks LE, van der Wekken AJ, de Langen AJ, Bahce I, Thunnissen E, et al. Treatment and survival of patients with EGFR-mutated non-small cell lung cancer and leptomeningeal metastasis: A retrospective cohort analysis. Lung Cancer 2015;89:255–61.

- Hammerer V. Diagnostic et traitement des méningites carcinomateuses en cancérologie bronchique. Revue des Maladies Respiratoires 2007 ; Vol 24, N° 8-C2 :222-5.

- Deangelis LM, Boutros D. Leptomeningeal metastasis. Cancer Invest 2005;23(2): 145-54.

- Pavlidis N, “The Diagnostic and Therapeutic Management of Leptomeningeal Carcinomatosis,” Annals of Oncology, Vol. 15, Supplement 4, 2004, pp. iv285-iv91.

- Tagle P, Villanueva P, Torrealba G, Huete I. Intracranial metastasis or meningioma? An uncommon clinical dilemma. Surg Neurol 2002; 58: 241-5.

- Laigle-Donadey F, Taillibert S, Mokhtari K, Hildebrand J, Delattre JY. Dural metastases. J Neurooncol 2005; 75: 57-61.

- El Asri AC, Gazzaz M, Akhaddar A, Naama O, Boulahroud Belhachmi A, et al. Les metastases méningées solitaires prévalentes. AJNS 2009 Vol. 28, No 1 (https://ajns.paans.org/journals/ajns-2009-vol-28-no-1/) Consulté le 05/06/2019.

- Praddat P.F., Delattre J.Y. Méningites chroniques. EMC 2008 17-160-C-30 p: 1-18.

- Takakura K, Sano K, Hojo S. Metastatic tumors of the central nervous system. Tokyo : Igaku Shoin, 1982.

- Collard M., Gut J.P., Christmann D., Hirsch E., Nastorg G., Sellal F. et al. L’encéphalite à tiques en Alsace. Rev Neurol 1993 ; 149 : 198-201.

- Strady C, Ricciarelli A, Nasca S, Liautaud-Roger F, Coninx P. Carcinomatous meningitis and solid tumours. Oncol Rep 2000 ; 7 : 203-7.

- Nugent JL, Bunn PA, Jr., Matthews MJ, Ihde DC, Cohen MH, Gazdar A, Minna JD : CNS metastases in small cell bronchogenic carcinoma: increasing frequency and changing pattern with lengthening survival. Cancer 1979 ; 44 : 1885-93.

- Aroney RS, Dalley DN, Chan WK, Bell DR, Levi JA : Meningeal carcinomatosis in small cell carcinoma of the lung. Am J Med 1981 ; 71 : 26-32.

- Posner JB, Chernik NL. Intracranial metastases from systemic cancer. Adv Neurol 1978 ; 575-8.

- Gonzales-Vitale JC, Garcia-Bunuel R. Meningeal carcinomatosis. Cancer 1976 ; 37 : 2906-11.

- Anderson NE, Willoughby EW. Chronic meningitis without predisposing illness: A review of 83 cases. Q J Med 1987 ; 63 : 283-95.

- Theodore WH, Gendelman S : Meningeal carcinomatosis. Arch Neurol 1981 ; 38 : 696-9.

- Chamberlain MC, Kormanik PA : Carcinoma meningitis secondary to non-small cell lung cancer: combined modality therapy. Arch Neurol 1998 ; 55 : 506-12.

- Little JR, Dale AJ, Okazaki H : Meningeal carcinomatosis. Clinical manifestations. Arch Neurol 1974 ; 30 : 138-43.

- Twijnstra A, Van Zanten AP, Nooyen WJ, Ongerboer De Visser BW. Sensitivity and specificity of single and combined tumour markers in the diagnoses of leptomeningeal metastases from breast cancer. J Neurol Neurosurg Psychiatry 1986: 49; 1246-50.

- Hopkins AP, Harvey PK. Chronic benign lymphocytic meningitis. J Neurol Sci 1973 ; 18 : 443-53.

- Pachner AR, Steere AC. The triad of neurologic manifestations of Lyme disease: meningitis, cranial neuritis, and radiculoneuritis. Neurology 1985 ; 35 : 47-53.

- Wasserstrom WR, Glass JP, Posner JB : Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer 1982 ; 49 : 759-72.

- Hammerer .V, Pauli G, Quoix É : Étude rétrospective d’une série de 26 cas de méningite carcinomateuse secondaire à un cancer bronchique. Bull Cancer 2005; 92: 1-6.

- Chamberlain MC, Kormanik PA: Prognostic significance of coexistent bulky metastatic central nervous system disease in patients with leptomeningeal metastases. Arch Neurol 1997; 54:1364-8.

- Collie DA, Brush JP, Lammie GA, Grant R, Kunkler I, Léonard R, Gregor A, Sellar RJ: Imaging features of leptomeningeal metastases. Clin Radiol 1999; 54:765-71.

- Pauls et al. Les forms particulières: Les méningites carcinomateuses. Eur J Radiol 2012; 81 :974-8.

- Brem SS, Bierman PJ, Brem H, Butowski N, Chamberlain MC, et al. Recommandations NCCN : JNCCN 2011 ; 9 : 352-400.

- Reuler JB, Meier D : Leptomeningeal carcinomatosis with normal CSF features. Arch Intern Med 1979 ; 139 : 237-8.

- Murray JJ, Greco FA, Wolff SN et al. Neoplastic meningitis. Marked variations of cerebrospinal fluid composition in the absence of extradural block. Am J Med 1983 ; 75 : 289-94.

- Glass JP, Melamed M, Chernik NL et al. Malignant cells inCSF: the meaning of a positive CSF cytology. Neurology 1979 ; 29 : 1369-75.

- Theodore WH, Gendelman S : Meningeal carcinomatosis. Arch Neurol 1981 ; 38 : 696-9.

- Freilich RJ, Krol G, Deangelis LM: Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastasis. Ann Neurol 1995; 38:51-5.

- Posner JB. Neurologic Complications of Cancer. Philadelphia, PA: F.A. Davis Company, 1995 p:482.

- Theodore WH, Gendelman S : Meningeal carcinomatosis. Arch Neurol 1981 ; 38 : 696-9.

- Praddat PF, Delattre JY. Méningites chroniques. EMC 2008 17-160-C-30 p:1-18.

- Delattre JY, Davila G, Poisson M. Les méningites carcinomateuses. Nevraxe 1990 ; 1 : 5-20.

- Herrlinger U, Forschler H, Kuker W, et al. Leptomeningeal metastasis: survival and prognostic factors in 155 patients. J Neurol Sci 2004;223: 167-78.

- Lee SJ, Lee JI, Nam DH, et al. Leptomeningeal carcinomatosis in non-small-cell lung can-cer patients: impact on survival and cor- related prognostic factors. J Thorac Oncol 2013;8:185–91.

- Park JH, Kim YJ, Lee JO, Lee KW, Kim JH, Bang SM, et al. Clinical outcomes of leptomeningeal metastasis in patients with non-small cell lung cancer in the modern chemotherapy era. Lung Cancer. 2012; 76:387–92.

- Umemura S, Tsubouchi K, Yoshioka H, Hotta K, Takigawa N, Fujiwara K, et al. Clinical outcome in patients with leptomeningeal metastasis from non-small cell lung cancer: Okayama lung Cancer study group. Lung Cancer. 2012;77:134–9.

- Pan Z, Yang G, He H, Zhao G, Yuan T, Li Y et al. Concurrent radiotherapy and intrathecal methotrexate for treating leptomeningeal metastasis from solid tumors with adverse prognostic factors: A prospective and single-arm study. Int J Cancer. 2016 Oct 15;139(8):1864-72.

- Park JH, Kim YJ, Lee JO, et al. Clinical outcomes of leptomeningeal metastasis in patients with non-small cell lung cancer in the modern chemotherapy era. Lung Cancer. 2012; 76 :387–92.

- Sakai M, Ishikawa S, Ito H, Ozawa Y, Yamamoto T, Onizuka M, Sakakibara Y : Carcinomatous meningitis from non-small-cell lung cancer responding to gefitinib. Int J Clin Oncol 2006 ; 11 :243-5.

- Hashimoto N, Imaizumi K, Honda T, Kawabe T, Nagasaka T, Shimokata K, Hasegawa Y : Successful re-treatment with gefitinib for carcinomatous meningitis as disease recurrence of non-small-cell lung cancer. Lung Cancer 2006 ; 53 : 387-90.

- Chouahnia K, Bréchot JM, Des-Guetz G, Saintigny P, Morère JF, Bréau JL : Gefitinib et méningite carcinomateuse d’un cancer bronchique non à petites cellules. Rev Mal Respir 2006 ; 23 : 149-51.

.


Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

********************************************************************************************