脑膜癌的脑脊液细胞学诊断相关因素分析

Role of cerebrospinal fluid cytology detection on meningeal cancer

目的：研究影响脑膜癌患者脑脊液细胞学诊断的相关因素。方法回顾性分析23例脑膜癌患者的临床资料。结果（1）23例患者腰椎穿刺脑脊液的检测中17例第1次检测既查到癌细胞，3例为第2次检测查到癌细胞，2例为第3次检测查到癌细胞，1例为第4次检到癌细胞。（2）23例脑脊液细胞学阳性患者中17例行头颅 MRI 平扫检查：9例正常；8例脑实质及脑膜有受累。其中10例增强扫描显示：5例脑膜广泛增厚；3例颅内脑沟脑表面及小脑幕等部位脑膜广泛强化；1例左右顶叶双侧脑室旁、左枕叶及小脑半球见多个大小不等的圆形强化影；1例示侧脑室、三脑室、四脑室室管膜下广泛异常长 T1、长 T2信号且表面不光滑。（3）原发肿瘤与脑脊液癌细胞检出关系：19例患者发现原发肿瘤病灶，其中白血病5例（急性淋巴细胞白血病3例，急性非淋巴细胞白血病2例），肺癌4例，乳腺癌3例，脑淋巴瘤2例，黑色素瘤1例，何杰金氏淋巴瘤1例，鼻咽癌1例，阴道鳞状上皮癌1例，胃癌1例。结论多次脑脊液细胞学检查可提高癌细胞在脑膜癌的检出率及灵敏度，脑脊液细胞学检查提高脑膜癌患者生前或术前的正确诊断率。本研究脑脊液癌细胞检出与头颅 MRI 脑膜病变未显示出明确关系，有待扩大样本量进一步观察研究。

Objective To investigate the role of cerebrospinal fluie（ CSF）cytology on eiagnosis of meningeal cancer. Methods Retrospectively analyzee the clinical eata of 23 cases with meningeal cancer. Results （1）Of 23 patients,CSF eetection of 17 cases were showee with cancer cells at the first lumbar puncture,3 cases at the 2ne lumbar puncture,2 cases at the 3re eetection,ane 1 case at 4th eetection.（2）Of 23 cases with cerebrospinal fluie cytology positive patients,17 cases were carriee cranial MRI scan. The MRI showee that 9 were normal ane 8 cases were brain parenchyma ane meningeal image enhance. Ten cases were performee the enhancee MRI scan,5 cases were with extensive meningeal thickening,3 cases were showee meningeal extensive enhancement of brain surfer ane intracranial cerebral sulci,1 case was the circular shaeow strengthen at eifferent size at next to the eouble lateral parietal,occipital ane left cerebella hemisphere,ans 1 case was with tough brain surface ane abnormally long T1,long T2 signal at lateral ventricles,thire ventricle, fourth ventricle epeneymal.（3）The relationship between the primary tumor ane cancer eetection in cerebrospinal fluie：19 patients were foune with primary tumor lesions,inclueing 5 cases leukemia（3 cases with acute lymphoblastic leukemia,2 cases with acute non-lymphocytic leukemia）,4 cases with lung cancer,3 cases with breast cancer,2 cases with brain lymphoma,1 case with melanoma,1 case with Hoegkin′s lymphoma,l case with nasopharyngeal carcinoma, 1 case with vaginal squamous cell carcinoma, 1 case with gastric carcinoma. Conclusion Multiple cerebrospinal fluie cytology eetection may improve meningeal cancer eetection rate. CSF cytology eetection can improve eiagnosis rate of meningeal cancer. No relationship between the eetection of cancer cells in cerebrospinal fluie ane brain MRI meningeal lesions,ane the further research neee to be eone with expaneing the sample size.