Carcinomatous and Leukemic Meningitis

Because patients with malignancies are now surviving for longer periods, carcinomatous and leukemic meningitis is becoming more common. The most frequent solid malignancies to involve the meninges are those of the breast, lung, gastrointestinal tract, and genitourinary tract, and malignant melanomas (Table 1). In most patients, neoplastic meningitis occurs late in the course of the disease when the cancer is far advanced. Patients with acute lymphocytic and acute myelogenous leukemia and patients with high-grade non-Hodgkin’s lymphoma are also at high risk of meningeal infiltration, which can be reduced by prophylactic intrathecal chemotherapy and radiation of the CNS. Primary brain tumors such as germinoma, ependymoma, and medulloblastoma may also invade the meninges.