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Leptomeningeal Disease — SCE Medical Oncology MCQ

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HardBreast CancerLeptomeningeal DiseaseSCE Medical Oncology

A 58-year-old woman with metastatic breast cancer develops new bilateral lower extremity weakness. MRI spine shows no cord compression. Brain MRI is normal. LP shows malignant cells. Cytology confirms adenocarcinoma consistent with breast origin. What is the diagnosis?

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Correct answer: C — Leptomeningeal metastatic spread from the known breast adenocarcinoma

Malignant cells in CSF that are morphologically compatible with the known breast primary establish confirmed leptomeningeal metastatic spread in this clinical setting. An intramedullary metastasis requires a spinal-cord parenchymal lesion on MRI. Epidural cord compression requires epidural or vertebral disease producing compression, which MRI excludes. Paraneoplastic myelopathy does not produce malignant CSF cytology. Infective meningoradiculitis can cause weakness and CSF inflammation but not breast-adenocarcinoma cells.

Reference: EANO-ESMO clinical practice guideline for leptomeningeal metastasis (Published October 2023): https://pubmed.ncbi.nlm.nih.gov/37863528/; NICE NG99 brain tumours and metastases: recommendations (Updated January 2021; current surveillance): https://www.nice.org.uk/guidance/ng99/chapter/recommendations