sugar coating

So-called "sugar coating" or zuckerguss (German for sugar icing) refers to the appearance of diffuse linear/sheetlike leptomeningeal contrast enhancement in the brain or spinal cord due to drop metastases or leptomeningeal carcinomatosis. It is seen both as a result of CNS involvement from distant primaries as well as direct spread from CNS malignancies.

Primaries include:

• widespread metastatic disease (more common)
  • breast cancer
  • lung cancer
  • melanoma 
  • lymphoma and leukemia
• primary intracerebral malignancies
  • glioblastoma (GBM) and anaplastic astrocytoma
  • medulloblastoma
  • PNET
  • ependymoma
  • germinoma
  • choroid plexus carcinoma

Differential diagnosis

Considerations include:

• leptomeningeal inflammation/infection
• post-surgical/post-lumbar puncture changes
• prominent pial vessels
  • normally only present in the very midline
  • may be enlarged with spinal AVMs or AVFs

Siehe auch:

• vertebrale Metastasen
• intradural extramedullary metastases
• spinale Metastasen
• spinal nerve sheath tumours
• Neoplasien der Cauda equina
• intradural spinal involvement in leukaemia