Leptomeningeal carcinomatosis in non-small cell lung cancer patients: a continuing challenge in the personalized treatment era

Leptomeningeal metastases (LM) are the multifocal seeding of the leptomeninges by malignant carcinomatous cells [1]. Malignant cells can reach the meninges by several different pathways: haematogenous spread via arterial or venous circulation, perivascular lymphatic spread, endoneural and perineural spread, direct spread from metastases located in the brain or bone in proximity to the subarachnoid or ventricular spaces, and spread from choroid plexus and subependymal metastases. Two types of leptomeningeal tumor spread can be distinguished: the first with free-floating non-adherent cancer cells (diffuse type); and the second characterized by contrast-enhanced leptomeningeal nodules (nodular type).

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