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Leptomeningeal carcinomatosis of gastric adenocarcinoma is a rare and mainly secondary site of metastasis in solid tumors, with a devastating prognosis, lacking an efficient and standardized treatment approach [1]. Brain metastases in gastric cancer are extremely rare. The patient’s symptoms might be progressively severe headaches, behavioral disturbances, and weakness (Figure 1).

Figure 1: An axial view of CT-Scan of the brain without injection (A) and sagittal (B) section showing a spontaneously hyperdense extra-axial lesion in a biconvex lens, (C) MRI of the brain in T1 axial section showing an extra-axial frontal lesion.

Our patient a 69-year-old had a head CT scan that demonstrated a 40 mm extradural left frontal spontaneously hyperdense lesion consistent with extradural hematoma (Figure 1A & 1B). The cerebral MRI revealed a left frontal extradural lesion spontaneously hyperintense on the T1 and T2-weighted imaging with large surrounding edema having a slight mass effect on the homolateral ventricle and is not enhanced by the Gadolinium (Figure 1C). Magnetic Resonance Imaging (MRI) scans of the brain revealed leptomeningeal gadolinium enhancement [2].

This lesion was more consistent with a chronic epidural hematoma. The patient underwent surgery the next day. left frontal craniectomy revealed an extradural leptomeningeal tumor that was excised en bloc. The histological study found that the material was consistent with gastric adenocarcinoma. We hope this case image will raise awareness of this rare metastatic possibility in gastric cancer and its diagnosis and therapeutic challenges [3].

1. Vergoulidou M (2017) . Biomark Insights 12: 117727191769523.

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2. Kano M, Hihara J, Hirabayashi N, Sueda T (2019) . Int Cancer Conf J 8: 149-152.

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3. Baleiras MM, Graça J, Fernandes L, Chorão M, Vasques AC, et al. (2022) . Arch Clin Cases 9: 6-11.

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