SHM Converge Scientific Abstract ePoster Gallery-A Rare Paradoxical Case of Isolated Pancreatic Leptomeningeal Carcinomatosis.

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This case describes a 66-year-old man with pancreatic adenocarcinoma who initially presented with painless jaundice, elevated CA 19-9, and CT evidence of a pancreatic mass with omental metastasis. After ERCP biopsy confirmed pancreatic adenocarcinoma, he underwent Whipple surgery and completed 12 cycles of mFOLFIRINOX chemotherapy. He responded well, with no evidence of disease on serial imaging for 1.5 years and excellent functional status.<br /><br />Two years after diagnosis, he developed 10 days of neck pain radiating to the right shoulder and arm, followed by fatigue, anorexia, hallucinations, altered mental status, visual changes, and eventual blindness. Initial workup, including ophthalmologic and infectious evaluation, was unrevealing. Lumbar puncture showed markedly elevated opening pressure and cerebrospinal fluid cytology positive for malignant epithelial cells. Brain MRI demonstrated leptomeningeal enhancement, confirming isolated pancreatic leptomeningeal carcinomatosis (LC). Full-body CT showed no other active systemic disease, and CA 19-9 remained normal.<br /><br />The patient’s decline was attributed to isolated LC, a rare and aggressive complication of malignancy. Because of poor functional status, he was transitioned to hospice without further treatment.<br /><br />The report emphasizes that LC can present with nonspecific neurologic symptoms such as headache, radicular pain, confusion, hallucinations, and vision loss, and it should be considered even when systemic cancer appears controlled. Diagnosis relies on contrast-enhanced brain MRI and CSF cytology. Although LC is uncommon in solid tumors, pancreatic LC is especially rare, with only 17 prior cases identified and a median survival of about 10 weeks after diagnosis. Early recognition is important to guide palliative care and goals-of-care discussions.

Asset Subtitle

Kaitlyn C. Dykes

Meta Tag

Author List Ali Alqahtani, Amna Rana, Kaitlyn C. Dykes, Maneesh Jain, Tina Roy, Victor Nava, Yiannis Dimopoulos

Category Clinical Vignettes

Concept Carcinomatous Meningitis

Concept Lumbar Puncture Cytology

Concept Solid Tumor Cancer

Concept Neurological Manifestation

Concept Lumbar Puncture

Distinguished Non-Finalist

Presenter Organization Georgetown University Hospital, MedStar

Presenting Author Kaitlyn C. Dykes

Track Adult

Keywords

pancreatic adenocarcinoma

leptomeningeal carcinomatosis

painless jaundice

CA 19-9

Whipple surgery

mFOLFIRINOX chemotherapy

cerebrospinal fluid cytology

brain MRI

neurologic symptoms

hospice care

Carcinomatous Meningitis

Lumbar Puncture Cytology

Solid Tumor Cancer

Neurological Manifestation

Lumbar Puncture