J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://www.journalmc.org

Case Report

Volume 14, Number 1, January 2023, pages 13-18

Breast to Brain: A Case Report and Literature Review of Leptomeningeal Carcinomatosis

Figure 1. Pathology slides from a breast biopsy. (a) Micro calculi in a ductal pattern from left breast tissue. (b) Stromal sclerosis and infiltrating lobular cancer from left breast tissue. (c) Cells in a single file line, indicating lobular carcinoma from left breast tissue.

Figure 2. T1-weighted MRI image of the brain. Mild to moderate hydrocephalus (white arrow). T2 hyperintensity consistent with transependymal spread of CSF (red arrow). There is no evidence of mass. There is no abnormal gadolinium enhancement. CSF: cerebrospinal fluid; MRI: magnetic resonance imaging.

Figure 3. Pathology slides form the cerebrospinal fluid. (a) Enlarged nucleoli with cytoplasmic vacuoles on cerebrospinal fluid cytology (May Grunwald-Giemsa stain). (b) Wright stain indicating a nest of tumors with increased cytoplasm, non-spindled from cerebrospinal fluid cytology.

**Table 1.** Demographic Details and Diagnostic Modalities for Leptomeningeal Carcinomatosis (Review of Literature)
References	Age (years)	Sex	ER	PR	HER-2	Duration from breast cancer diagnosis to LC diagnosis (years)	Imaging
F: female; M: male; ER: estrogen receptor; PR: progesterone receptor; HER-2: human epidermal growth factor receptor 2; LC: leptomeningeal carcinomatosis; MRI: magnetic resonance imaging; CT: computed tomography; PET: positron emission tomography; CSF: cerebrospinal fluid; -: not mentioned.
[3]	65	F	Positive	Positive	Negative	18	PET, MRI
[4]	71	F	Positive	Positive	Negative	0	MRI
[5]	67	F	-	-	-	2	MRI
[6]	66	F	Negative	Negative	Positive	2	MRI
[7]	77	F	-	-	-	-	-
[8]	66	F	Positive	-	Negative	0	MRI

Table 1. Demographic Details and Diagnostic Modalities for Leptomeningeal Carcinomatosis (Review of Literature)

References

Age (years)

Sex

HER-2

Duration from breast cancer diagnosis to LC diagnosis (years)

Imaging

F: female; M: male; ER: estrogen receptor; PR: progesterone receptor; HER-2: human epidermal growth factor receptor 2; LC: leptomeningeal carcinomatosis; MRI: magnetic resonance imaging; CT: computed tomography; PET: positron emission tomography; CSF: cerebrospinal fluid; -: not mentioned.

[3]

Positive

Negative

PET, MRI

[4]

Positive

Negative

MRI

[5]

MRI

[6]

Negative

Positive

MRI

[7]

[8]

Positive

Negative

MRI

**Table 2.** Significant Laboratory Results From the Cerebrospinal Fluid
Spinal fluid	Patient value (units)	Reference range
µL: microliter; dL: deciliter; mg: milligram; RBCs: red blood cells; WBCs: white blood cells; CSF: cerebrospinal fluid; VDRL: Venereal Disease Research Laboratory.
Glucose, CSF	91 mg/dL	40 - 70 mg/dL
Protein, CSF	365 mg/dL	15 - 45 mg/dL
RBC, CSF	5 µL	0 µL
WBC, CSF	25 µL	0 µL
CSF VDRL	Non-reactive
Volume, CSF	2.75 mL

Table 2. Significant Laboratory Results From the Cerebrospinal Fluid

Spinal fluid

Patient value (units)

Reference range

µL: microliter; dL: deciliter; mg: milligram; RBCs: red blood cells; WBCs: white blood cells; CSF: cerebrospinal fluid; VDRL: Venereal Disease Research Laboratory.

Glucose, CSF

91 mg/dL

40 - 70 mg/dL

Protein, CSF

365 mg/dL

15 - 45 mg/dL

RBC, CSF

5 µL

0 µL

WBC, CSF

25 µL

0 µL

CSF VDRL

Non-reactive

Volume, CSF

2.75 mL