Leptomeningeal Carcinomatosis as an Initial and Sole Manifestation of Papillary Renal Cell Carcinoma

Inroduction: Leptomeningeal carcinomatosis (LMC) is an infrequent and devastating complication of systemic malignancy. Although it occurs in 5 – 20% of patients with metastatic cancer, its association with papillary renal cell carcinoma (RCC) is extremely rare. To the best of our knowledge, there are only 3 published case reports of leptomeningeal metastasis occurring in patients with papillary RCC. Case report: Herein, we describe a case of a 45 year old man presenting for the first time with a clinical picture of cauda equina syndrome. MRI spine was suggestive of leptomeningeal carcinomatosis and the diagnosis was confirmed with CSF cytology. Contrast enhanced CT abdomen, revealed a heterogeneous mass arising from the mid pole of left kidney. CT guided biopsy and histopathological examination confirmed the diagnosis of papillary RCC. There was no evidence of any other systemic metastasis. Conclusion: This case illustrates a rare occurrence of LMC as an initial and isolated metastatic manifestation of papillary RCC. Early diagnosis of this condition requires high index of clinical suspicion and an integrated approach using multiple diagnostic modalities.