Rare Association of Sugar Coating Cerebellum (Leptomeningeal Carcinomatosis) and Squamous Cell Carcinoma of Lung

Abstract

Purpose: We present a 30 year old young male presenting with cough, weight loss, poor appetite who was initially treated outside as a case of pulmonary tuberculosis. Patient was referred to our to our hospital with new onset of complainsof unsteadiness of gait, swallowing difficulty, headache. Methods: On examination he was disoriented with neck stiffness,bilateral nystagmus and bilateral cerebellar signs. Cerebrospinal fluid (CSF) analysis was normal showing no evidence of tuberculosis (TB) with TB PCR being negative. Bronchoalveolar lavage (BAL) done showed no evidence of infection. MRI Brain showed leptomeningeal enhancement scattered over cerebellum ‘sugar coated' manner. Sugar coating of cerebellum is classically seen in leptomeningeal carcinomatosis due to spread of malignant cells through CSF either from primary central nervous system (CNS) tumor or from distant tumors. For primary work up - USG neck showed supra clavicular lymph nodes. Biopsy of lymph nodesrevealed squamous cell carcinoma and PET scan showed metastatic bone deposits. So we confirmed the diagnosis of sugar coating of cerebellum is leptomeningeal carcinomatosis secondary to primary tumor in lung. Discussion: Leptomeningeal carcinomatosis is seen in approximately 5% of patients with lung cancer and incurs a bleak prognosis. Diagnosis is confirmed via lumbar puncture and cerebrospinal fluid cytology. However in our case CSF analysis was normal. Few data exist regarding optimal treatment, although intrathecal chemotherapy has been shown to provide a modest improvement in median survival.