Leptomeningeal Metastases in Carcinoma Rectum with Extensive Skeletal Metastasis - A Case Report

Abstract

Incidence of rectal carcinoma has been rising in younger people in recent decades. Skeletal metastasis without other organ metastasis from primary rectal carcinoma is very rare, spine and the pelvis are the first sites of bony metastasis. Leptomeningeal Metastases (LM) is a very rare complication of solid tumour progression and its incidence in colorectal carcinoma is far less. A nineteen-year-old male presented in the OPD with rectal bleeding and low back pain with colonoscopic biopsy proving rectal carcinoma. MRI of pelvis revealed multiple osseous metastases to vertebrae and pelvic bones. After four cycles of palliative chemotherapy, he developed lower back pain. Repeat MRI revealed multiple lesions in the vertebrae and long bones for which he received palliative external beam radiation therapy (EBRT). Subsequently seven months later he developed meningeal metastases and received whole brain radiation and supportive care. LM in patients with primary colorectal cancer (CRC) remains an exceedingly rare complication of metastatic disease progression in CRC. Colorectal cancer (CRC) is the third most common cancer diagnosed in both men and women.[1] The incidence of it has been rising in young adults.[2] The common metastatic sites of CRC include the liver (57.6%), abdominal lymph nodes (48.3%), lungs (37.6%) and Peritoneum.[3,4,5] Skeletal metastasis without other organ metastasis is very rare. Bone metastasis is seen in 4.7% to 10.9% in clinical cases and often indicates advanced disease with a poor prognosis with 5-year survival rate less than 5%,[6] leading to significantly high rate of morbidity and mortality. Leptomeningeal Metastases (LM) or neoplastic meningitis, is an uncommon metastatic complication of solid tumour progression. Most commonly arising from breast, non-small-cell lung cancer, and melanoma with a frequency of 5% to 25%.[7] The incidence of LM in colorectal cancer (CRC) is far less than 1%.[8] Here we report a case of rectal carcinoma, with extensive skeletal metastases and their pattern of bone involvement, who later presented with meningeal metastases.