癌性脑膜病3例及文献复习

Meningeal carcinomatosis: a report of 3 cases and review of literatures

目的探讨癌性脑膜病的病理机制及临床特点。方法回顾性分析一年内北京军区总医院神经内科收治的3例癌性脑膜病男性患者的临床特点,并通过复习文献,总结癌性脑膜病的病理机制、临床表现、诊断、治疗及预后。结果3例患者均以神经系统症状起病:病例1以头痛发病,3年前曾有胃癌手术史;病例2、3均以复视起病,病例3随后还出现下肢根性刺激痛和尿潴留。入院后检查,病例1未发现胃癌复发或全身转移;病例2、3被发现并确诊为肺癌。3例患者脑脊液改变大致相同:蛋白稍高,糖和氯化物减少。均于3例患者脑脊液中找到癌样细胞(异型细胞、印戒细胞、异型大圆细胞),且脑脊液中多种肿瘤标志物均呈阳性,增强头颅MRI可见脑膜异常强化。3例患者分别于死于脑膜癌病确诊后的第7、47、24天。结论神经症状可为癌性脑膜病的首发或唯一临床表现,对于无明显诱因的进行性神经系统损害,应进行详细的神经病学和肿瘤学检查。

Objective To explore the clinical features of meningeal carcinomatosis （MC）. Methods The clinical data of 3 male patients with MC, administered to the authors＇ hospital within one-year period, were retrospectively analyzed. The pathological mechanism, clinical manifestations, diagnosis, treatment and the prognosis were summarized and relevant literature was reviewed. Results All the three patients presented neurological symptoms at the onset. Case 1, 52-year-old having a history of radical resection for gastric cancer 3 years ago, suffered from headache for 2 months without apparent digestive symptoms. Case 2, 71-year-old, presented diplopia for 2 months. Case 3, 46-year-old, complained diplopia for 3 months, followed by left hip pain and urinary retentions. For case 1, examinations after admission suggested no signs of local recurrence or systemic metastasi. For case 2 and 3, lung tumors were detected and then pulmonary carcinoma was diagnosed. Cerebrospinal fluid （CSF） of the three patients showed similar changes, including mild increase of protein, decrease of glucose and chlorides Carcinous cells （heterocyst, signet-ring cell and large round heterocyst） were found and cells with positive tumor markers were found in the CSF of all the three patients. MRI also showed specific enhancement on meninges. All these patients, died on day 7, 47 and 24 respectively, after the diagnosis was established. Conclusions Neurological symptoms might be the earliest or the exclusive clinical features of meningeal carcinoma metastasis. A detailed neurological and oncological examination is necessary for the patients with progressive neurological lesions without obvious precipitating cause.