Case Report Leptomeningeal Dissemination in Gall Bladder Carcinoma: Sequelae of Long-Term Survival? Shikha Goyal and Bidhu Kalyan Mohanti Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi 110019, India Correspondence should be addressed to Shikha Goyal; drshikhagoyal@gmail.com Received 24 July 2014; Accepted 14 October 2014; Published 5 November 2014 Academic Editor: Hideaki Uchiyama Copyright © 2014 S. Goyal and B. K. Mohanti. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Patients with gall bladder malignancies usually present at an advanced stage with less than 20% cases being resectable at presentation and over a half harbouring distant metastases to liver or paraaortic nodes. Long-term cure is uncommon and so is the presence of central nervous system metastases. We present the case of a middle-aged woman with adenocarcinoma gall bladder, treated with postoperative locoregional irradiation following simple cholecystectomy, who developed headache, backache, vision loss, and multiple joint pains six years following adjuvant therapy. A diagnosis of leptomeningeal carcinomatous meningitis was established with cerebrospinal luid cytology positivity for carcinoma. She deteriorated on palliative cranial irradiation and was managed with best supportive care. 1. Introduction Gall bladder adenocarcinoma is an aggressive disease, with the best surgical series reporting a survival of 63% following an extended cholecystectomy in T3 disease [1]. Survival is dismal in the absence of completion surgery following inadvertent detection on laparoscopic cholecystectomy. Five- year survival in most large series is under 5% and median sur- vival less than six months. Dissemination is early, with over 50% of cases harbouring metastatic disease at presentation, commonest site being the liver [2]. We present a case of a lady with carcinoma gall blad- der treated with laparoscopic cholecystectomy and adjuvant radiotherapy, who developed neoplastic meningitis 6 years following initial therapy. 2. Case Summary A 54-year-old lady presented to our department with a history of low backache for three months, painless pro- gressive loss of vision in both eyes for 25 days, multiple joint pains, and headache for 20 days. here was no history of seizures, altered sensorium, motor, or sensory deicit apart from the aforementioned vision loss. Six years earlier, she had been diagnosed to have well diferentiated ade- nocarcinoma gall bladder T3NxM0 incidentally diagnosed following cholecystectomy, for which she denied completion cholecystectomy and received adjuvant radiotherapy by 3- dimensional conformal radiotherapy. Planning target volume consisted of gall bladder fossa with 2 cm margin and portal, celiac, superior mesenteric, and paraaortic nodal regions. A dose of 45 Gray in 25 fractions was delivered on a Linear accelerator with 6 MV photons using three ields (two wedged lateral opposed portals and one anterior portal conforming to the delineated volumes on CT scan). She had been on regular followup without any evidence of recurrence over the past six years. Her vital signs were unremarkable, apart from mild pallor. Neurological examination revealed bilateral papilledema on fundoscopy. here was no mem- ory impairment, cranial nerve palsy, or motor or sensory deicit. Visual acuity was 6/60 in both eyes ater pinhole correction. Deep tendon relexes were present and bilateral plantar relexes were downgoing. here was no neck rigidity. Complete blood counts and serum biochemistry returned normal. Serum electrophoresis, coagulation proile, and vas- culitis workup were unremarkable. Cerebrospinal luid (CSF) Hindawi Publishing Corporation Case Reports in Hepatology Volume 2014, Article ID 717403, 3 pages http://dx.doi.org/10.1155/2014/717403