Neoplastic Meningitis Due to Lung, Breast, and Melanoma Metastases

Emilie Le Rhun, MD; Sophie Taillibert, MD; Marc C. Chamberlain, MD

Disclosures

Cancer Control. 2017;24(1):22-32. 

In This Article

Physiopathology

Tumor cells invade the leptomeninges and CSF by various means, including via hematogenous spread (either through arterial dissemination or through the Batson venous plexus), endoneural/perineural or perivascular lymphatic spread, and direct extension from the brain parenchyma or choroid plexus. Primary leptomeningeal tumors may be also observed, particularly with melanoma.[9]

After entering the subarachnoid space, cancer cells disseminate through the neuraxis via the dynamic flow of the CSF and metastasize to multiple sites in the CNS.[4] Tumor cell infiltration of the CSF predominates at the base of the brain, the dorsal spinal cord, and the cauda equina.[8] Two pathological patterns of neoplastic meningitis can be distinguished and are often related: (1) subarachnoid or intraventricular nodular disease, and (2) nonadherent malignant cells suspended and circulating in CSF (ie, circulating tumor cells [CTCs]).[6]

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