Often known as neoplastic meningitis or leptomeningeal metastasis, carcinomatous meningitis (CM) refers to the invasion of tumor cells by meninges that protect the brain and spinal cord. It should be differentiated from brain metastasis, where metastatic cells are invaded by brain parenchyma. More cases of CM are being diagnosed lately with enhanced overall survival of most cancers with advances in cancer treatment. The primary source of cancer cells may move to the meninges in different ways: vertebral and paravertebral metastases (breast and lung cancer), perineural spaces (gastrointestinal cancer), parenchymal metastasis arteries, and rarely by direct invasion (primary central nervous system tumors). Depending on the region of the central nervous system involved, patients often present with non-specific symptoms, such as headache and altered mental state, or focal neurological signs. Early detection is key due to poor prognosis and limited effectiveness in treating it. Diagnosis by cerebrospinal fluid (CSF) cytology (identifying malignant cells) and/or imaging has limited efficacy in suspicious cases. The need to use different biomarkers in CSF to increase the likelihood of a diagnosis of CM in solid tumors is addressed in this study. Biomarkers can also assist in the prediction of the burden of the disease, treatment response, and recurrence detection. In order to diagnose CM, fluorescence in situ hybridization (FISH), rare cell capture technology (RCCT) and circulating tumor DNA (CtDNA) are also addressed in the detection of malignant cells in CSF. However, in larger cohorts, the definitive position of these modalities in combination requires further confirmation.
Author (s) Details
Department of Pathology, University of Alabama, Birmingham, UK.
Department of Hematology and Oncology, University of Alabama, Birmingham, UK.
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