Krukenberg Tumor with Leptomeningeal Carcinomatosis Misdiagnosed as Acoustic Neuroma

Objective: Leptomeningeal carcinomatosis (LMS) is defined as the diffuse infiltration of the leptomeninges and subarachnoid space by malignant cells metastasizing from systemic cancer. Patients usually have a known underlying malignancy, but primary presentation can be with symptoms of meningeal involvement. We describe a rare case of Krukenberg tumor with LMS initially presented as bilateral progressive sensorineural hearing loss, which was misdiagnosed as acoustic neuroma. Patient: A 50 year old man with a history of cervical cancer was referred to the Ear Nose and Throat (ENT) clinic because of progressive hearing loss, tinnitus, dizziness and blurred vision for 5 months. Results: A CT scan of the abdomen and pelvis showed a right adnexal mass, suspicious for an ovarian neoplasm. The patient underwent surgical resection of her pelvic mass. Surgical pathology revealed poorly differentiated adenocarcinoma with scattered signet ring cells, favorable with metastatic gastric adenocarcinoma. Magnetic resonance imaging revealed abnormal leptomeningeal enhancement. A lumbar puncture was performed, the CSF analysis showed elevated protein and positive for signet malignant cells. Conclusion: Our case highlights the importance of the development of new diagnostic tools and treatment regimens for LMC.