Development of meningeal carcinomatosis in advanced gastric cancer - PowerPoint PPT Presentation

ESMO Preceptorship Programme Brain Tumours – Athens – 28-29/9/2018 Development of meningeal carcinomatosis in advanced gastric cancer Dr. Michele Ghidini Operative Unit of Oncology, Cancer Center, ASST of Cremona, Italy

Disclosure slide I have no actual or potential conflict of interest in relation to this program/presentation ESMO PRECEPTORSHIP PROGRAMME

Past medical history 72 years old, mother affected by gastric cancer;  Non-smoker, no-alcohol consumption, no allergies. Ex-farmer;  Past hydrocele and inguinal hernioplasty.  July 2013: persistent heartburn → gastroscopy with evidence of  multiple gastric ulcers . Multiple biopsies performed. Histology: adenocarcinoma ; September 2013: total-body CT scan: no evidence of disease;  26 November 2013: total gastrectomy with histology: gastric  adenocarcinoma, grade 2, pT1b pN0 (0/35) R0, early gastric cancer. Post-surgical development of cholangitis and splenic abscesses  treated with ceftriaxone, ampicillin-sulbactam and levofloxacin with final resolution ESMO PRECEPTORSHIP PROGRAMME

Recent medical history 17 November 2016: gastroscopy . Multiple biopsies  Histology:  high-grade displasia ; January 2017: persistent fever → total-body CT scan: multiple  splenic abscesses and diffuse ascites . Gastroscopy : bleeding lesion at the esophagogastroduodenal anastomosis . Histology: adenocarcinoma; 29 March 2017: distal esophagectomy, splenectomy and  cholecystectomy . Histology: adenocarcinoma, grade 3, pT4 pN3 (20/31) R0, M+ (splenic metastases). Post-surgical severe fatigue and nutrition issues. Parenteral nutrition  started. 31 May 2017: CT scan: nodal relapse with retroperitoneal nodes  (maximum diameter 22 mm). CEA and CA 19.9: negative. ESMO PRECEPTORSHIP PROGRAMME

First line treatment Inclusion in clinical phase III first-line trial of maintenance avelumab or  continuation of chemotherapy after a 12-weeks induction first-line chemotherapy with oxaliplatin and fluoropyrimidine; From 28 June to 6 September 2017: 6 cycles of FOLFOX regimen ;  14 August 2017: total-body CT scan after 4 cycles : partial  response ; 14 September 2017: Re-baseline total body CT scan after 6 cycles:  stable disease ; 27 September 2017: First cycle of avelumab.  ESMO PRECEPTORSHIP PROGRAMME

Admission to hospital 3 October 2017: onset of severe headache and dizziness . Cranial  CT scan: suspected posterior fossa meningioma. Brain MRI execution suggested; Brain MRI: pathological contrast enhancement in posterior fossa  (cerebellum, pons, midbrain ) → LEPTOMENINGITIS; ESMO PRECEPTORSHIP PROGRAMME

BRAIN MRI ESMO PRECEPTORSHIP PROGRAMME

Neurologic assessments Lumbar puncture: negative assessments for bacterial or viral  meningitis. Positive cytology for malignant cells. CSF analysis: 49 leucocytes/mm3 ( 98% mononuclear, 2%  polymorphonuclear ); glucose 33.4 mg/dL (n.v. 40-70); proteins 132.20 mg/dL (n.v. 15-45); albumin 70.95 mg/dL (n.v. 13-24) Fast worsening of clinical conditions with onset of coma  DEATH on 10 October 2017  ESMO PRECEPTORSHIP PROGRAMME

ESMO Preceptorship Programme Thanks for your attention micheleghidini@outlook.com