13例颅内恶性黑色素瘤的脑脊液临床特点分析

Clinical characteristics of cerebrospinal fluid in 13 cases of intracranial malignant melanoma

目的探讨颅内恶性黑色素瘤(intracranial malignant melanoma,IMM)患者的临床、影像学磁共振成像(magnetic resonance imaging,MRI)、脑脊液生化、脑脊液常规和细胞学的特点,提高对IMM的诊断能力。方法回顾性分析2021年12月至2023年8月广东三九脑科医院收治的13例IMM患者的临床表现、影像学MRI、脑脊液生化、脑脊液常规和细胞学特点。结果13例IMM患者中,脑脊液常规多数外观无色透明(62%,8例)或血性浑浊(15%,2例),蛋白阳性(54%,7例),有核细胞数正常(38%,5例)或轻度增高(62%,8例);脑脊液细胞学可呈淋巴-单核细胞反应型(31%,4例)或混合细胞反应型(23%,3例),均找到黑色素肿瘤细胞(100%,13例);脑脊液生化中多数蛋白(53%,7例)、乳酸脱氢酶(77%,10例)和乳酸(77%,10例)升高;常见症状有头痛(77%,10例)、头晕(38%,5例)、乏力(38%,5例);MRI示脑膜有异常强化(92%,12例)。结论IMM患者有一些脑脊液常规和细胞学、脑脊液生化、临床表现、MRI表现的特点,能给临床医师提供帮助,特别是在脑脊液找到黑色素肿瘤细胞对诊断有重大意义,病理诊断可最终确诊。

Objective To investigate the clinical,imaging,magnetic resonance imaging(MRI),cerebrospinal fluid biochemistry,routine,and cytological features of patients with intracranial malignant melanoma(IMM),and to improve the diagnostic ability of IMM.Methods The clinical manifestations and imaging MRI,cerebrospinal fluid biochemical,routine,and cytological characteristics of 13 patients with IMM admitted to Guangdong 999 Brain Hospital from December 2021 to August 2023 were retrospectively analyzed.Results Among the 13 patients,the cerebrospinal fluid was colorless and transparent in 8 cases(62%),was muddy in 2 cases(15%),and was protein-positive in 7 cases(54%);the number of nucleated cells was normal in 5 cases(38%),and was slightly increased in 8 cases(62%);the cerebrospinal fluid cytology was lympho-monocyte response type in 4 cases(31%),and was mixed cell response type in 3 cases(23%);melanoma cells were found in all the 13 cases(100%).The cerebrospinal fluid biochemistry showed that the protein increased in 7 cases(53%),lactate dehydrogenase increased in 10 cases(77%),and lactic acid increased in 10 cases(77%).The common symptoms were headache(77%,10 cases),dizziness(38%,5 cases),and fatigue(38%,5 cases).MRI showed abnormal enhancement of meninges(92%,12 cases).Conclusion IMM has some characteristics of cerebrospinal fluid routine and cytology,cerebrospinal fluid biochemistry,clinical manifestations,and MRI manifestations,which can provide clinicians with great help.Especially,finding melanoma cells in cerebrospinal fluid is of great significance for diagnosis,and pathological diagnosis can confirm the final diagnosis.