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Carbohydrate antigen 19–9 in cerebrospinal fluid and within malignant cells in a case of leptomeningeal carcinomatosis
  1. YOSHIHIRO SATO
  1. Department of Neurology, Futase Social Insurance Hospital, Iizuka 820, Japan
  2. Department of Pathology, St Mary’s Hospital, Kurume 830, Japan
  3. Department of Internal Medicine, Kurume University School of Medicine, Kurume 830, Japan
  1. Dr Yoshihiro Sato, Department of Neurology, Kurume University Medical Center, 155–1 Kokubumachi, Kurume 839–0863, Japan. Telephone 0081 942 22 6111; fax 0081 942 22 6533; emaily-sato{at}ktarn.or.jp
  1. YOSHITAKA OHTA,
  2. MASAHIDE KAJI
  1. Department of Neurology, Futase Social Insurance Hospital, Iizuka 820, Japan
  2. Department of Pathology, St Mary’s Hospital, Kurume 830, Japan
  3. Department of Internal Medicine, Kurume University School of Medicine, Kurume 830, Japan
  1. Dr Yoshihiro Sato, Department of Neurology, Kurume University Medical Center, 155–1 Kokubumachi, Kurume 839–0863, Japan. Telephone 0081 942 22 6111; fax 0081 942 22 6533; emaily-sato{at}ktarn.or.jp
  1. KOTARO OIZUMI,
  2. MASAHIDE KAJI
  1. Department of Neurology, Futase Social Insurance Hospital, Iizuka 820, Japan
  2. Department of Pathology, St Mary’s Hospital, Kurume 830, Japan
  3. Department of Internal Medicine, Kurume University School of Medicine, Kurume 830, Japan
  1. Dr Yoshihiro Sato, Department of Neurology, Kurume University Medical Center, 155–1 Kokubumachi, Kurume 839–0863, Japan. Telephone 0081 942 22 6111; fax 0081 942 22 6533; emaily-sato{at}ktarn.or.jp

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Carcinoembryonic antigen (CEA) concentrations in CSF hold promise as an indicator of metastatic leptomeningeal involvement by carcinoma.1 2 We describe a patient with leptomeningeal carcinomatosis showing a high concentration of carbohydrate antigen 19–9 (CA 19–9) but a normal CEA concentration in CSF despite equally positive immunostaining in the cytoplasm of tumour cells in CSF.

A 44 year old man was admitted complaining of headaches and diplopia over 3 months. Neurologically, the patient was alert despite neck stiffness. Multiple cranial nerve dysfunction was apparent, specifically bilateral lateral gaze palsy, inability to move his jaw due to masseter palsy, facial diplegia, left soft palate weakness, and absence of gag reflex on the left. Four limb ataxia was evident, and his gait was wide based and unsteady. Reflexes were symmetrically hypoactive in all extremities and pathological reflexes were absent.

Chest CT disclosed nodular, contrast enhancing, left upper lung densities. Gastric fibroscopy and abdominal CT were unrevealing. Non-contrast brain MRI was normal. On lumbar puncture, opening pressure was high (160 mm H2O). His CSF was xanthochromic and contained 9 cells/mm3, 117 mg/dl protein, and 48 mg/dl glucose. Cytological examination of CSF disclosed scattered large cells with irregularly shaped, polymorphic nuclei, sometimes with large cytoplasmic vacuoles characteristic of adenocarcinoma (fig 1 A, B). The CEA concentration (radioimmunoassay: …

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