Carcinomatosis meníngea en paciente con meningitis a Streptococcus pneumoniae
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Rev. Inv. Inf. Sal.
Abstract
Paciente mujer de 43 años sin antecedente oncológico conocido, que ingresó por un cuadro meníngeo por Streptococcus pneumoniae con hipertensión endocraneana y deterioro neurológico. Durante la evolución, la citología de líquido cefalorraquídeo mostró células malignas poco cohesivas; la tomografía por emisión de positrones objetivó captación patológica a nivel endometrial y adenopatías pélvicas, y la histeroscopia con biopsia endometrial evidenció metástasis de carcinoma pobremente diferenciado. El panel inmunohistoquímico en tejido endometrial fue: ER+/PR+, GATA-3+, CK7+, y HER2/CK20/mamoglobina, hallazgos que orientaron a carcinoma de origen mamario pobremente diferenciado, con probable diferenciación lobulillar. Se planteó carcinomatosis meníngea con compromiso sistémico y se comenzó manejo multidisciplinario incluyendo quimioterapia intratecal con metotrexato. Este caso ilustra la presentación atípica del carcinoma lobulillar invasivo, la importancia de paneles inmunohistoquímicos para el diagnóstico diferencial y la necesidad de un alto índice de sospecha ante metástasis en sitios inusuales.
A 43-year-old female patient with no known history of cancer was admitted with meningitis caused by Streptococcus pneumoniae, accompanied by intracranial hypertension and neurological deterioration. During her clinical course, cerebrospinal fluid cytology revealed poorly cohesive malignant cells; positron emission tomography showed pathological uptake in the endometrium and pelvic lymphadenopathy; and hysteroscopy with endometrial biopsy revealed metastasis of poorly differentiated carcinoma. The immunohistochemical panel in endometrial tissue was: ER+/PR+, GATA-3+, CK7+, and HER2/CK20/mammoglobin, findings suggestive of poorly differentiated carcinoma of breast origin, with probable lobular differentiation. Meningeal carcinomatosis with systemic involvement was suspected, and multidisciplinary management was initiated, including intrathecal chemotherapy with methotrexate. This case illustrates the atypical presentation of invasive lobular carcinoma, the importance of immunohistochemical panels for differential diagnosis, and the need for a high index of suspicion when metastases occur in unusual sites.
A 43-year-old female patient with no known history of cancer was admitted with meningitis caused by Streptococcus pneumoniae, accompanied by intracranial hypertension and neurological deterioration. During her clinical course, cerebrospinal fluid cytology revealed poorly cohesive malignant cells; positron emission tomography showed pathological uptake in the endometrium and pelvic lymphadenopathy; and hysteroscopy with endometrial biopsy revealed metastasis of poorly differentiated carcinoma. The immunohistochemical panel in endometrial tissue was: ER+/PR+, GATA-3+, CK7+, and HER2/CK20/mammoglobin, findings suggestive of poorly differentiated carcinoma of breast origin, with probable lobular differentiation. Meningeal carcinomatosis with systemic involvement was suspected, and multidisciplinary management was initiated, including intrathecal chemotherapy with methotrexate. This case illustrates the atypical presentation of invasive lobular carcinoma, the importance of immunohistochemical panels for differential diagnosis, and the need for a high index of suspicion when metastases occur in unusual sites.
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Vol. 20, No. 49