系统性淋巴瘤软脑膜转移的脑脊液细胞学分析

Cytological analysis of cerebrospinal fluid in leptomeningeal metastasis of systemic lymphoma

目的探讨CSF细胞学及免疫细胞化学对系统性淋巴瘤软脑膜转移的诊断价值。方法回顾性分析我院5例系统性淋巴瘤转移至软脑膜的病例,分析其CSF细胞学及免疫细胞化学特点。结果5例患者中男性3例,女性2例,年龄14~74岁,平均年龄45岁。患者主要临床症状为头痛及恶心呕吐。此外,1例伴有发热,1例伴有脑神经损害,表现为眼肌麻痹。患者MRI扫描显示脑实质内均未发现异常信号,仅2例有脑膜强化。常规CSF细胞学显示5例CSF中均含有大量异型淋巴样细胞。免疫细胞化学显示4例CSF中CD20和/或CD79α阳性的异型细胞比例显著增加,这4例患者之前有脑外B细胞淋巴瘤病史;1例CSF中CD3阳性异型细胞为主。此患者随后发现了乳腺肿瘤,最终诊断为间变性大细胞淋巴瘤。5例CSF中异型细胞均与原发部位肿瘤细胞免疫表型一致,因此系统性淋巴瘤转移至软脑膜诊断明确。结论CSF细胞学对系统性淋巴瘤的软脑膜转移诊断有重要意义,联合免疫细胞化学检测可进一步明确诊断。少数无系统性淋巴瘤病史的患者需要积极检查寻找原发肿瘤的起源和部位。

Objective To explore the diagnostic value of CSF cytology and immunocytochemistry in leptomeningeal metastasis of systemic lymphoma.Methods The CSF cytological and the immunocytochemical characteristics of 5 cases of systemic lymphoma with leptomeningeal metastasis from our hospital were analyzed retrospectively.Results The 5 patients included 3 males and 2 females with a median age of 45 years,the age range was 14 to 74 years.The main clinical manifestation were headache,nausea and vomiting.Otherwise,one case was accompanied with fever and another case was accompanied with cerebral nerve injury,which showed ophthalmoplegia.Brain MRI showed no abnormal signal in all 5 cases,but leptomeningeal enhancement in 2 cases.The CSF of all the 5 cases had a number of atypical lymphoid cells.Immunocytochemistry showed a significant increase in the percentage of CD20 and/or CD79α positive cells in 4 patients who had a history of extracerebral B cell lymphoma before and CD3 positive cells predominance in 1 patient.The last patient was then found a breast tumor,which was finally diagnosed anaplastic large cell lymphoma.The immunophenotype of the atypical cells was the same as the primary lymphoma cells in all 5 cases which confirm the diagnosis of metastatic leptomeningeal lymphoma.Conclusions CSF cytology is useful for the detection of systemic lymphoma with leptomeningeal metastasis,and the diagnosis can be further clarified when it combined with immunocytochemistry.A few patients without a history of systemic lymphoma need active investigations to find the origin and location of the primary tumor.