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Leptomeningitis carcinomática por cáncer de vejiga que imita la cerebellitis relacionada con el sistema inmunológico:
Filippo Cordaro1, Andrea Barresi1, Francesco Bencivinni2
1Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy.
Resumen
Carcinomatosis leptomeníngea, una rara complicación del cáncer de vejiga, presentada con síntomas no específicos. Este caso pone de relieve el desafío de diagnóstico, especialmente con la inmunoterapia, y la necesidad de una evaluación rápida.
Área de la Ciencia:
- En el campo de la oncología
- Neurología
Sus antecedentes:
- Un hombre de 65 años con antecedentes de tabaquismo, hipertensión y dislipidemia presentó disuria y hematuria.
- Las imágenes revelaron cáncer de vejiga invasivo muscular y engrosamiento rectal; las biopsias confirmaron carcinoma urotelial de alto grado (pT2) y adenocarcinoma rectal.
Objetivo del estudio:
- Para reportar un caso raro de carcinomatosis leptomeníngea secundaria al carcinoma urotelial.
- Discutir los desafíos de diagnóstico y el manejo de esta rara complicación, particularmente en pacientes sometidos a inmunoterapia.
Principales métodos:
- Tomografías con contraste y resonancia magnética para la estadificación del tumor y la evaluación neurológica.
- Examen histopatológico de las biopsias y citología del líquido cefalorraquídeo (LCR) para el diagnóstico.
- El tratamiento incluyó quimioterapia (gemcitabina / cisplatino, luego carboplatino), radioterapia e inmunoterapia (Avelumab).
Principales resultados:
- El paciente desarrolló síntomas neurológicos (dolor en el cuello, inestabilidad postural) después del inicio de la inmunoterapia.
- La neuroimagen mostró edema cerebeloso y aumento leptomeningeal, inicialmente sospechado como efectos paraneoplásicos o relacionados con la inmunoterapia.
- El análisis del LCR confirmó metástasis leptomeníngeas de origen urotelial, a pesar de los hallazgos negativos iniciales en el PET-CT para las metástasis distantes.
Conclusiones:
- La carcinomatosis leptomeníngea es una manifestación rara pero crítica del carcinoma urotelial.
- El diagnóstico puede ser difícil debido a los síntomas no específicos y a la superposición con los efectos secundarios de la inmunoterapia.
- La neuroimagen temprana y la citología del LCR son cruciales; el manejo es principalmente paliativo.
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