薄层离心脑脊液肿瘤细胞学阳性85例临床病理分析

The clinical and pathological features of 85 cases with positive cerebrospinal fluid cytology by thin-layer centrifugal cytological test

目的研究脑脊液肿瘤细胞学阳性病例的临床病理特征，探讨薄层离心脑脊液细胞学检测在诊断脑膜肿瘤细胞播散性病变中的应用价值。方法回顾性分析首都医科大学宣武医院2013--2015年采用薄层离心法制片检测的6316份脑脊液标本中肿瘤细胞阳性的85例病例的临床及影像学资料、细胞形态学特点及免疫细胞化学染色结果。结果85例确诊肿瘤细胞阳性的病例临床主要表现为脑膜刺激征阳性及神经功能障碍；影像学主要表现为脑膜增厚、强化或皮层异常信号，部分病例可见占位性病变。利用薄层离心细胞学技术所制切片85例中有84例（98．8％）为第1次送检脑脊液标本即发现异型细胞，48例进一步行免疫细胞化学染色明确了肿瘤细胞来源，其中最常见的病变是脑膜癌病（51例），以肺癌最多见（12例），组织类型主要为腺癌（10例），其他包括淋巴造血系统肿瘤13例，黑色素细胞性病变5例，原始神经外胚层肿瘤（PNET）3例及胶质瘤1例。此外，还有12例仅脑脊液证实为肿瘤细胞，但肿瘤细胞的确切来源未知。结论脑膜肿瘤细胞播散性病变的诊断需依赖临床表现、影像学及脑脊液细胞学检测，其中脑脊液细胞学发现肿瘤细胞是明确诊断的金标准。薄层离心脑脊液细胞学检测保证了脑脊液肿瘤细胞阳性病例的检出率，辅助免疫细胞化学染色可帮助进一步明确病变来源及类型，因而在诊断脑膜肿瘤细胞播散性病变，尤其是脑膜癌病中有着重要的作用和意义。

Objective To evaluate cytological test of cerebrospinal fluid in the diagnosis of meningeal dissemination of tumor cells. Methods The clinical and imaging features of 85 cases with tumor cells diagnosed by thin-layer centrifugal cytological test of cerebrospinal fluid were retrospectively reviewed. The characteristics of cellular morphology and immunocytochemical staining were analyzed. Results The main presentations of all the patincts was meningeal irritation and neurological dysfunction. The features of the brain MRI were meningeal thicking and enhancement, intracranial abnormal signals and intracranial space occupying lesion in part of the patients. Atypical cells were found in 84 cases （98.8%） with the first sample test and immunocytochcmical staining was conducted in 48 cases to identify the tissue origin. Meningeal carcinomatosis was shown to be the majority with lung cancer as the dominated tissue type and adenocarcinoma as the most common histological type. Others were lymphatic hematopoietic system （13 cases） , melanomas （ 5 cases ） , primitive neuroectodermal tumor （ 3 cases ） and glioma （ 1 case ） . In addition, 12 cases were only proved to be cancer by cytological test of cerebrospinal fluid. Conclusion The thin-layer centrifugal cytological test of cerebrospinal fluid has a relatively high accuracy for detecting disseminated tumor cells of meninges and could be of great help to identify the source and type of lesion with immunocytochemical staining.