Case ReportCerebrospinal Fluid Leak Rhinorrhea after Systemic Erlotinib Chemotherapy for Metastatic Lung Cancer: A Familiar Problem from an Unfamiliar Culprit
Section snippets
Background
Cerebrospinal fluid (CSF) rhinorrhea is a rare but well-described entity after the medical therapy of a pituitary prolactinoma.1, 2 A robust response to dopamine agonist therapy leads to rapid shrinkage of the tumor, which, in the event of an eroded sellar floor skull base dura and/or bony structures, can lead to a conduit between the nasal passages and the subarachnoid space. Interestingly, although the mechanism for most cases is due to tumor shrinkage from medical management, allowing the
History
The patient was a 66-year-old woman with an extensive smoking history who presented to her pulmonologist with shortness of breath and subsequently was diagnosed with a pulmonary embolism as well as a new lung mass and multiple smaller systemic lesions. A diagnosis of stage IV EGFR-mutant adenocarcinoma of the lung was made after biopsy of the chest mass. She noted continual headaches, and so magnetic resonance imaging of the brain was performed, which showed and an enhancing mass of the sella
Discussion
CSF rhinorrhea is a potential serious complication of endoscopic endonasal surgery and also rarely of medical management of prolactinoma. To our knowledge, no report of metastatic lung adenocarcinoma complicated by CSF rhinorrhea arising from targeted therapy (e.g., erlotinib) has been published. The complication of CSF rhinorrhea is not a process strictly inherent to pituitary pathology such as prolactinoma. Rather, any neoplastic process that creates a fistula, when treated and after
Conclusions
We report a case of systemic erlotinib therapy leading to CSF rhinorrhea in a patient with stage IV adenocarcinoma of the lung due to rapid shrinkage of a sellar/clival metastasis. This mechanism appears similar when compared with other treatment modalities, whereby a tumor regresses quickly, allowing exposure of a previously created CSF fistula from tumor invasion of bone and dura. Surgical repair of these leaks is technically simple and is crucial to perform before the development of
References (12)
- et al.
Delayed CSF rhinorrhea after gamma knife radiosurgery with or without preceding transsphenoidal resection for pituitary pathology
World Neurosurg
(2017) - et al.
Inhibitors of epidermal-growth-factor receptors: a review of clinical research with a focus on non-small-cell lung cancer
Lancet Oncol
(2003) - et al.
Is surgical intervention frequently required for medically managed macroprolactinomas? A study of spontaneous cerebrospinal fluid rhinorrhea
Surg Neurol
(2009) - et al.
Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature
Neurosurg Focus
(2012) - et al.
Bromocriptine or cabergoline-induced cerebrospinal fluid rhinorrhea: a life-threatening complication during management of prolactinoma
J Hum Reprod Sci
(2011) - et al.
CSF rhinorrhoea following treatment with dopamine agonists for massive invasive prolactinomas
Clin Endocrinol (Oxf)
(2000)
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Conflict of interest statement: Daniel Prevedello is a consultant for Medtronic and Codman (J&J) and has received an honorarium from Leica Microsystems. All other authors do not have any conflict of interests.