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CSF positive for carcinoma cells after 7-years of breast surgery is rare but possible. What molecular events turn a quiescent lesion into an expanding one, causing symptoms is poorly understood, but probably has to do with angiogenesis factors. The smears are intensely cellular, with large cell size, and hyperchromatic nuclei, with occasional formation of "one cell gland". On purely cytological grounds, they are indistinguishable from metastatic carcinomas of other organs.
"Adenocarcinomas are the most common tumors to metastasize to the leptomeninges, although any systemic cancer can do so. Small-cell lung cancers spread to the leptomeninges 9-25% of the time, melanomas 23%, and breast cancers 5%; however, because of the differing relative frequencies of these cancers, most patients with Leptomeningeal Carcinomatosis have breast cancer." (R A Sewell, in eMedicine article)
| Case A November 2003 | Case C November 2003 | References | List of cases | Atlas |