Leptomeningeal carcinomatosis as presenting symptom of a gallbladder carcinoma

Introduction. Meningeal carcinomatosis is rare accounting for 4-5% in autopsy of patients with solid tumors, and even less frequent, 1% in its pure form without brain metastases. We report a case of psychosis symptomatic of a meningeal carcinomatosis as presenting manifestation of a gallbladder carcinoma. This clinicopathological combination has not been described previously. Case report. 74 years-old man. His past medical history included Parkinson's disease treated with t-dopa 50 mg/8 hour and selegiline; duodenal ulceration and hypertiroidism. He started with delirium and visual hallucinations that do not responded to a reduction of L-dopa and suppression of selegiline. The examination of CSF was diagnostic, malignant cells were identified in the initial examination. The patient dead and his autopsy diagnostic was gallbladder carcinoma with meningeal carcinomatosis. Conclusions. Leptomeningeal carcinomatosis in its pure form is the infiltration of the leptomeninges without brain metastases. It is less than 1% of meningeal metastases from solid tumors. The most frequent primary tumors are: lung, breast, stomach-esophagus, melanoma, cole-rectal genital and urinary; and the most frequent histological type is adenocarcinoma. The commonest presenting symptoms are focal brain, medullar or radicular symptoms. Psychiatric as isolated symptom are exceptional. Diagnosis is confirmed by the examination of CSF. Malignant cells appear in the first examination in 45-50% of cases. Leptomeningeal carcinomatosis in gallbladder carcinoma is rare; only four cases has been described previously none of them presenting as isolated psychiatric clinical picture.