Main Article Content


Incidence of rectal carcinoma has been rising in younger people in recent decades. Skeletal metastasis without other organ metastasis from primary rectal carcinoma is very rare, spine and the pelvis are the first sites of bony metastasis. Leptomeningeal Metastases (LM) is a very rare complication of solid tumour progression and its incidence in colorectal carcinoma is far less. A nineteen-year-old male presented in the OPD with rectal bleeding and low back pain with colonoscopic biopsy proving rectal carcinoma. MRI of pelvis revealed multiple osseous metastases to vertebrae and pelvic bones. After four cycles of palliative chemotherapy, he developed lower back pain.  Repeat MRI revealed multiple lesions in the vertebrae and long bones for which he received palliative external beam radiation therapy (EBRT). Subsequently seven months later he developed meningeal metastases and received whole brain radiation and supportive care. LM in patients with primary colorectal cancer (CRC) remains an exceedingly rare complication of metastatic disease progression in CRC.

Colorectal cancer (CRC) is the third most common cancer diagnosed in both men and women.[1] The incidence of it has been rising in young adults.[2] The common metastatic sites of CRC include the liver (57.6%), abdominal lymph nodes (48.3%), lungs (37.6%) and Peritoneum.[3,4,5] Skeletal metastasis without other organ metastasis is very rare. Bone metastasis is seen in 4.7% to 10.9% in clinical cases and often indicates advanced disease with a poor prognosis with 5-year survival rate less than 5%,[6] leading to significantly high rate of morbidity and mortality.

Leptomeningeal Metastases (LM) or neoplastic meningitis, is an uncommon metastatic complication of solid tumour progression. Most commonly arising from breast, non-small-cell lung cancer, and melanoma with a frequency of 5% to 25%.[7] The incidence of LM in colorectal cancer (CRC) is far less than 1%.[8]

Here we report a case of rectal carcinoma, with extensive skeletal metastases and their pattern of bone involvement, who later presented with meningeal metastases.

Article Details

How to Cite
Chayan Paul, Abhishek Basu, & Abhay Chakravarty. (2023). Leptomeningeal Metastases in Carcinoma Rectum with Extensive Skeletal Metastasis - A Case Report. Journal of Evolution of Medical and Dental Sciences, 12(10), 308–312.


  1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015;65(2):87-108.
  2. American Cancer Society: Colorectal Cancer facts and figures: 2020-2022. Atlanta, GA, American Cancer Society, 2020.
  3. Hugen N, van de Velde CJ, de Wilt JH, et al. Metastatic pattern in colorectal cancer is strongly influenced by histological subtype. Ann Oncol 2014;25(3):651-7.
  4. Holch JW, Demmer M, Lamersdorf C, et al. Pattern and dynamics of distant metastases in metastatic colorectal cancer. Visc Med 2017;33(1):70-5.
  5. Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer 1950;3(1):74-85.
  6. Kawamura H, Yamaguchi T, Yano Y, et al. Characteristics and prognostic factors of bone metastasis in patients with colorectal cancer. Dis Colon Rectum 2018;61(6):673-8.
  7. Grossman S, Krabak M. Leptomeningeal carcinomatosis. Cancer Treat Rev 1999;25(2):103-19.
  8. Giglio P, Weinberg JS, Forman AD, et al. Neoplastic meningitis in patients with adenocarcinoma of the gastrointestinal tract. Cancer 2005;103(11):2355-62.
  9. Ahmed SZ, Cirocchi N, Saxton E, et al. Incidence of age migration of colorectal cancer in younger population: retrospective single centred-population based cohort study. Ann Med Surg (Lond) 2021;74:103214.
  10. Yaffee P, Osipov A, Tan C, et al. Review of systemic therapies for locally advanced and metastatic rectal cancer. J Gastrointest Oncol 2015;6(2):185-200.
  11. Schlüter K, Gassmann P, Enns A, et al. Organ-specific metastatic tumor cell adhesion and extravasation of colon carcinoma cells with different metastatic potential. Am J Pathol 2006;169(3):1064-73.
  12. Kanthan R, Loewy J, Kanthan SC. Skeletal metastases in colorectal carcinomas: a Saskatchewan profile. Dis Colon Rectum 1999;42(12):1592-7.
  13. Connelly TM, Piggott RP, Waldron RM, et al. Unusual osseous metastases from rectal adenocarcinoma: a case report and review of the literature. J Gastrointest Surg 2015;19(6):1177-86.
  14. Libson E, Bloom RA, Husband JE, et al. Metastatic tumours of bones of the hand and foot. Skeletal Radiol 1987;16:387-92.
  15. Portales F, Thézenas S, Samalin E, et al. Bone metastases in gastrointestinal cancer. Clin Exp Metastasis 2015;32(1):7-14.
  16. O'Sullivan GJ, Carty FL, Cronin CG. Imaging of bone metastasis: an update. World J Radiol 2015;7(8):202-11.
  17. Taylor G, Karlin N, Halfdanarson TR, et al. Leptomeningeal carcinomatosis in colorectal cancer: the mayo clinic experience. Clin Colorectal Cancer 2018;17(2):e183-7.
  18. Börger ME, Gosens MJ, Jeuken JW, et al. Signet ring cell differentiation in mucinous colorectal carcinoma. J Pathol 2007;212(3):278-86.
  19. Shah L, Salzman K. Imaging of spinal metastatic disease. Int J Surg Oncol 2011;2011:769753.
  20. Slouma M, Abbes M, Dhahri R, et al. Rectal carcinoma revealed by isolated mixed bone metastases. Clin Case Rep 2022;10:e05380.
  21. Rastogi R, Meena GL, Wani AM, et al. Rectal carcinoma with osteosclerotic metastases-a rare occurrence. J Cancer Diagn 2016;1:104.
  22. Song JY, Dwyre DM. Metastatic adenocarcinoma involving the bone marrow. Blood 2012;120(16):3170.
  23. Nakashima Y, Takeishi K, Guntani A, et al. Rectal cancer with disseminated carcinomatosis of the bone marrow: report of a case. Int Surg 2014;99(5):518-22.
  24. Zeeneldin A, Al-Dhaibani N, Saleh YM, et al. Anorectal cancer with bone marrow and leptomeningeal metastases. Case Rep Oncol Med 2018;2018:9246139.
  25. Ito H, Horie H, Sadatomo A, et al. Metachronous solitary metacarpal bone metastasis from rectal cancer. Journal of Surgical Case Reports 2017;12:247.
  26. Paik JH, Shin HJ, Lee HS, et al. Case report of periorbital metastasis from rectal cancer. Medicine 2020;99(1).
  27. Bresalier RS, Karlin DA. Meningeal metastasis from rectal carcinoma with elevated cerebrospinal fluid carcinoembryonic antigen. Dis Colon Rectum 1979;22(4):216-7.
  28. McFadzean R, Brosnahan D, Doyle D, et al. A diagnostic quartet in leptomeningeal infiltration of the optic nerve sheath. J Neuroophthalmol 1994;14(3):175-82.
  29. Sartore-Bianchi A, Pedrazzoli P, Ponchio L, et al. Meningeal carcinomatosis in rectal cancer. Clin Oncol 2002;14:82.
  30. Jariengprasert C, Laothamatas J, Janwityanujit T, et al. Bilateral sudden sensorineural hearing loss as a presentation of metastatic adenocarcinoma of unknown primary mimicking cerebellopontine angle tumor on the magnetic resonance image. Am J Otolaryngol 2006;27(2):143-5.
  31. Suzuki T, Sakaguchi H, Yamamoto S, et al. Sudden hearing loss due to meningeal carcinomatosis from rectal carcinoma. Auris Nasus Larynx 2006;33(3):315-9.
  32. Su PJ, Hsieh CH, Yang TS. Leptomeningeal carcinomatosis from a primary colon cancer patient. J Cancer Res Pract 2011;27(3):113-6.
  33. Bruce BB, Tehrani M, Newman NJ, et al. Deafness and blindness as a presentation of colorectal meningeal carcinomatosis. Clin Adv Hematol Oncol 2010;8(8):564-6.
  34. Le Rhun E, Taillibert S, Chamberlain MC. Carcinomatous meningitis: leptomeningeal metastases in solid tumors. Surg Neurol Int 2013;4(Suppl 4):S265-88.
  35. Tham YL, Hinckley L, Teh BS, et al. Long-term clinical response in leptomeningeal metastases from breast cancer treated with capecitabine monotherapy: a case report. Clin Breast Cancer 2006;7(2):164-6.