31例成人脑膜癌病的临床及脑脊液细胞学特点研究

Clinical and cerebrospinal fluid cytology features of 31 cases of adult meningeal carcinomatosis

目的探讨脑膜癌病的临床表现及脑脊液细胞学特点。方法收集2014年6月至2018年6月南京医科大学附属脑科医院神经内科收治的31例脑膜癌病患者临床资料,对其临床表现、影像学表现、肿瘤标志物特点、脑脊液细胞学特点进行分析。结果 31例患者中男13例,女18例,年龄42~73(59.5±8.8)岁。18例患者既往有肿瘤病史,以亚急性头痛为主要临床表现,常伴有颅压增高。91.7%(22/24)患者肿瘤标志物升高,磁共振脑膜强化占47.4%。脑脊液细胞学常伴有轻度炎性反应,均发现可疑异形细胞,行免疫组织化学染色,明确为转移性癌细胞。结论对既往无肿瘤病史中老年患者,病程半年内的亚急性头痛,需充分检查,排除脑膜癌病。肿瘤标志物筛查、头颅MRI增强等无创检查有助于提高该病诊断,但确诊需要腰穿查脑脊液细胞学。对可疑异形细胞,建议作免疫组织化学检测。

Objective To investigate the clinical and cerebrospinal fluid（CSF） cytology characteristics of meningeal carcinomatosis（MC）.Methods Thirty one patients with MC were retrospectively analyzed in the authors＇ affiliated hospital from June 2014 to June 2018,diagnosed by CSF cytology.Results In 31 patients,13 were male and 18 were female,the average age was（59.5±8.8） years old.Eighteen cases had a history of tumor,and the main clinic manifestation was sub-acute headache,accompanied intracranial hypertension.Tumor marker raised in 91.7% patients,enhanced magnetic resonance imaging（MRI） showed leptomeningeal enhancement in 47.4% individuals.CSF cytology demonstrated mild inflammatory reaction,and all of 31 patients were found suspicious heterocyst.The immunohistochemical staining was positive which ascertained metastatic cancer cell.Conclusions Middle-aged and elder patients without a history of tumor,subacute headache within 6 months,MC should be exclude.Tumor marker,enhanced MRI were helpful to improve the diagnosis of MC Noninvasively,definite diagnosis depended on CSF cytology.Immunohistochemical staining should be check while suspicious heterocyst was found.