PMC4809332_01
Radiological findings observed on initial visit.. Notes: (A) Chest radiograph revealed right pleural effusion. (B) Chest computed tomography revealed a mass in segment 6 of the right lower lobe.
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Her clinical stage was T2aN0M1b, stage IV with multiple bone metastases and pleural dissemination (Figure 1).
Gadolinium-enhanced MRI of the head on day 48 after the initiation of gefitinib.. Note: Hydrocephalus was detected without intracranial metastases.
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Gadolinium-enhanced MRI of the head showed hydrocephalus without parenchymal metastases (Figure 2).
Radiological findings before and after VP shunt placement.. Notes: (A) Hydrocephalus on the head CT had worsened compared with the head MRI performed before the initiation of erlotinib. A low-density area was observed in the white matter of the bilateral frontal lobe because of intracranial hypertension 3 months after switching from gefitinib to erlotinib. (B) A head CT after VP shunt placement indicated that the malignant hydrocephalus had improved.. Abbreviations: VP shunt, ventriculoperitoneal shunt; CT, computed tomography.
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A computed tomography (CT) scan of the head demonstrated that the hydrocephalus had worsened (Figure 3A). Although this treatment approach improved her hydrocephalus (Figure 3B), complete blindness and a bilateral hearing disorder developed as a result of direct invasion of LM lesions into the relevant nerves.
Gadolinium-enhanced MRI of the head after emergency placement of the VP shunt.. Notes: Gadolinium-enhanced MRI showed diffuse enhancement of the cranial dura mater. No evidence of brain parenchymal metastases was observed. (A) Thickening and enhancement of the dura mater in the optic nerve canal were observed (white arrows). (B) Thickening and enhancement of the dura mater in the auditory nerve canal were observed (white arrows).. Abbreviation: VP shunt, ventriculoperitoneal shunt.
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The optic canal and internal auditory canal were also enhanced (Figure 4).
The clinical course of this patient.. Abbreviations: G, gefitinib; E, erlotinib; Bev, bevacizumab; WBRT, whole-brain radiotherapy; VP shunt, ventriculoperitoneal shunt; ECOG PS, Eastern Cooperative Oncology Group Performance Status; LM, leptomeningeal metastases.
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She died as a result of LM progression 10 months after the initial diagnosis (Figure 5).