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Abstract:
An anatomopathologic study of 18 cases of pure meningeal carcinomatosis is presented. In five of these cases, the brain, spinal cord, choroid plexuses, cerebral vessels, and prevertebral soft tissues, including the lumbosacral nerve plexuses and ganglia, were examined microscopically in an attmept to determine the routes of tumor spread. Our results suggest that the malignant cells reach the cerebrospinal leptomeninges via perineural, endoneural, and perivascular lymphatics and sheaths through the intervertebral and possibly cranial foramina. Involvement of the choroid plexuses appears to be secondary to, rather than the avenue for, leptomeningeal carcinomatosis, with the tumor cells reaching the choroid plexuses via the perivascular sheaths of choroidal vessels. Leptomeningeal carcinomatosis was the only manifestation of metastatic spread beyond regional lymph nodes in about 40% of all reported cases in which this information is available. This implies that radiation or other forms of local therapy to the cerebrospinal leptomeninges may provide an effective means of palliation in many of these cases.
Insights
Malignant cells spread to the cerebrospinal leptomeninges via perineural, endoneural, and perivascular lymphatics. This anatomopathologic study suggests local therapy may effectively palliate meningeal carcinomatosis.
Area of Science:
- Neuropathology
- Oncology
- Anatomopathology
Background:
- Meningeal carcinomatosis (MC) is a rare complication of cancer.
- Understanding tumor spread routes is crucial for effective treatment.
Purpose of the Study:
- To investigate the routes of tumor spread in pure meningeal carcinomatosis.
- To examine the role of choroid plexuses in MC.
Main Methods:
- Anatomopathologic examination of 18 cases of pure MC.
- Microscopic analysis of the brain, spinal cord, and associated structures in 5 cases.
Main Results:
- Malignant cells likely spread via perineural, endoneural, and perivascular lymphatics through foramina.
- Choroid plexus involvement appears secondary, with tumor cells reaching via perivascular sheaths.
- MC was the sole metastatic manifestation beyond regional lymph nodes in 40% of cases.
Conclusions:
- Perineural, endoneural, and perivascular lymphatics are key routes for MC.
- Local therapy targeting the cerebrospinal leptomeninges may offer effective palliation.