Ann Rehabil Med.  2014 Dec;38(6):861-864. 10.5535/arm.2014.38.6.861.

Chest Wall Pain as the Presenting Symptom of Leptomeningeal Carcinomatosis

• Sim KB
• Nam KY
• Lee HJ
• Park JW
• Ryu GH
• Chang J
• Kwon BS

• KMID: 2267100
• DOI: http://doi.org/10.5535/arm.2014.38.6.861

Abstract

Leptomeningeal metastasis (LMM), also referred to as leptomeningeal carcinomatosis, results from diffuse infiltration of the leptomeninges by malignant cells originating from extra-meningeal primary tumors. It occurs in approximately 5%-10% of patients with solid tumor. Among solid tumors, the most common types leading to infiltration of the leptomeninges are breast cancer, lung cancer, and melanoma. Patients with LMM may present various signs and symptoms. Herein, we report a rare case with initial presentation of isolated chest wall pain. Computed tomography of the chest with contrast revealed a 2.5-cm nodule over the left upper lung. Biopsy confirmed the diagnosis of adenocarcinoma. Later, cerebrospinal fluid cytology exam also confirmed leptomeningeal seeding. It is rare for leptomeningeal carcinomatosis patients to present with chest wall pain. Therefore, a high index of suspicion is mandatory for accurate and prompt diagnosis.

Keyword

Meningeal carcinomatosis; Neoplasm metastasis; Chest pain; Lung cancer; Leptomeningeal metastasis

MeSH Terms

Adenocarcinoma
Biopsy
Breast Neoplasms
Cerebrospinal Fluid
Chest Pain
Diagnosis
Humans
Lung
Lung Neoplasms
Melanoma
Meningeal Carcinomatosis*
Neoplasm Metastasis
Thoracic Wall*
Thorax

Figure

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  Fig. 1 Axial and coronal view of the chest computed tomography demonstrating a 2-cm sized irregular lobulation and well as an enhanced nodule at the left upper lobe.

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  Fig. 2 Sagittal view of the lumbar spinal magnetic resonance imaging with contrast showing multiple various sized spinal intradural extramedullary metastases.

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  Fig. 3 Multiple focal hypermetabolic nodules are observed in the spinal space at the thoracic level.

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