Carcinomatous meningitis in a patient with metastatic breast cancer.

Metastases are defined as the appearance of neoplasms in parts of the body remote from the site of the primary tumor. Metastasis can occur through one of three processes: direct seeding of body cavities or surfaces, lymphatic spread, and hematogenous spread. The importance of laboratory utilization in the diagnosis of metastasis is explored using a case study of a 39-year-old female with metastatic breast carcinoma to the brain. This case study was carried out using clinical records, laboratory results, pathology reports, and physician interviews. Cerebrospinal fluid was obtained and examined in hematology, chemistry, and microbiology. Tissue from the breast was examined both before and after chemotherapy. Morphologic comparisons of both primary and metastatic tumor cells were carried out. The breast tissue showed infiltrating mammary carcinoma, ductal type, with 8/11 auxiliary lymph nodes showing metastasis. Evaluations of cerebrospinal fluid cell count results revealed the presence of malignant cells in remarkable numbers. Based on cytological and hematological results, a diagnosis of meningeal carcinomatosis was determined and treatment was started. Following the intrathecal chemotherapy, serial cerebrospinal fluid examinations showed the percentage of malignant cells decreased and no cells were detected 11 days after treatment. Metastasis, including meningeal carcinomatosis is a common occurrence with breast carcinoma. An effective chemotherapeutic treatment is evaluated for this disease when an accurate diagnosis is made. As demonstrated by this case study, proper use of the laboratory can help establish the diagnosis of metastasis.