[A case of meningeal carcinomatosis showing myelopathy--detection of TNF-alpha in infiltrating CSF cells and brain tissue sections of cerebellum].

A 41-year-old woman had radical mastectomy for breast cancer with metastasis of axial lymph nodes three years previously. In February 1990, she noticed swelling of lymph nodes in right suparclavicular region. A lymph node biopsy revealed cancer cells. Immediately, radiation therapy was performed. However, in August serum levels of CA 15-3 and LDH were markedly elevated. Two months later the patient complained of severe headache, dysarthria, shoulder pain and anorexia. Neurological examination revealed stiff neck, weakness of bilateral facial muscles, deviation of tongue to the left and no sensory disturbance. A CSF sample by lumbar puncture showed 26/mm3 in cell counts, 204 mg/dl of protein and 11 mg/dl of glucose. In addition, CSF cytology revealed malignant cells four to five times as large as lymphocytes. Immediately, and intrathecal administration of methotrexate (MTX) was started. However, one week later she developed complete paraplegia with sensory disturbance below the L1 levels and an incontinentia urine. CSF examination performed again, and showed 97/mm3 in cell counts, 792 mg/dl of protein and 91 mg/dl of glucose. On October 10, a CT scan of the head showed contrast enhancement along cerebellar folia and narrowing of quadrigeminal cistern. On November 31, sagittal T1W1 with Gadolinium revealed an enhancing stripes along the spinal cord at the Th10 to L4 levels. This finding was suggested to be meningeal carcinomatosis. On December 8, she died. At autopsy, brownish hemorrhagic mass was noticed in the bilateral cerebellar tonsils, and severe downward displacement of the tonsils.(ABSTRACT TRUNCATED AT 250 WORDS)