Little George McIntosh suffers from a disseminated olligodendrial leptomeningeal
tumour which, until now, has only been found in adults and never a child.
Magnetic resonance imaging (MRI) with contrast showed bilateral subcortical and external capsule fluid-attenuated inversion recovery (FLAIR) and diffusion weighted imaging (DWI) hyperintensities, with perirolandic predominance (Figure 2, panels A, B) without leptomeningeal
or parenchymal enhancement.
Dominic, of Low Fell in Gateshead, is one of only a handful of children in the world diagnosed with disseminated leptomeningeal
Table 1: Health Canada-approved Oncological Indications Drug Health Canada Approved Cancer Indications Standard Chemotherapy Cisplatin Bladder, ovarian, testicular Methotrexate Acute lymphocytic leukemia, breast, bladder, choriocarcinoma, gastric, head and neck, non-Hodgkin's lymphoma, metastasis of unknown primary, osteogenic sarcoma, leptomeningeal
spread of malignancies Targeted Therapy Bevacizumab Colorectal, lung (NSCLC), brain Cetuximab Colorectal Crizotinib Lung (NSCLC) Panitumumab Colorectal Vemurafenib Melanoma Note: Many of the agents above have numerous uses in non-approved indications.
PKC plans to evaluate the effectiveness of this strategy in an upcoming clinical trial in patients diagnosed with leptomeningeal
carcinomatosis and who have also had HER2 positive breast cancer.
Findings can include abnormal leptomeningeal
and pachymeningeal enhancement, abnormal cortical FLAIR signal, diffusion restriction, and/or hydrocephalus (Figure 1).
Aquaporin 4 was present in high amounts in astrocytes and ependymocytes and in low amounts in the choroidal plexus epithelia and leptomeningeal
thickening with contrast enhancement were detected on T1-weighted images (Figure 1 A,B).
12) Flow cytometry has established itself as a valuable tool in complementing cytology in the detection of hematologic malignancies, especially in secondary CNS lymphoma, where leptomeningeal
involvement is more common than parenchymal involvement and, hence, more accessible to lumbar puncture.
On cranial magnetic resonance imaging (MRI), the FLAIR image showed mild hyperintensity in the left Sylvian fissure, and contrast-enhanced T1-weighted MRI showed suspect leptomeningeal
enhancement in the left Sylvian fissure (Figure 1).
Follow-up tests revealed Harper had leptomeningeal
carcinomatosis, a rare type of cancer that occurs in the meninges, thin membranes, that surrounds the brain and spinal cord.
A 31-year-old male patient with Hodgkin's lymphoma (HL) and leptomeningeal
involvement presented to at Hematology Departments of Ataturk University.