老年人脑膜癌病临床病理分析

The clinicopathologic features of the meningeal carcinoma

目的 探讨老年人脑膜癌病临床病理特点。 方法 对 78例≥ 60岁的脑膜癌病患者的临床症状、体征进行分析 ,对其脑脊液细胞片进行免疫细胞化学标记 (ABC法 ) ,并随访。 结果 1.临床表现 :85 90 % (67例 )的患者以头痛为主要临床表现 ;14 10 % (11例 )表现为头晕 ;有 17 95 % (14例 )伴有发热 ;另有 6 41% (5例 )伴有视物模糊。 2 .标记结果 :全部癌细胞上皮膜抗原 (EMA) (+ ) ,细胞角蛋白 (CK) (+ ) ,CD14 (-) ,胶质酸性蛋白(GFAP) (-)。其中 ,5 4例CK高分子 (+ ) ,CK低分子 (-) ,诊断为转移性腺癌 ;18例CK高分子 (-) ,CK低分子(+ ) ,诊断为转移性鳞癌 ;6例CD高分子 (+ ) ,CK低分子 (+ )考虑为腺鳞癌。 3 .随访结果 :3 6例 (4 6 15 % )确诊为肺癌 ;11例 (14 10 % )在消化道内找到原发灶 ;4例 (5 13 % )为乳腺癌 ;子宫内膜癌、卵巢癌、肝癌各 1例。另有 2 4例(3 0 77% )未找到原发灶。 5 4例诊断明确者中 ,5 0例 (92 5 9% )的患者于确诊后 3～ 14月死亡。未找到原发灶的患者中 ,2 2例 (91 67% )在 2～ 13月内死亡。 结论 1.脑膜癌病患者以头痛、头晕为主要临床表现 ,并可伴有发热及视物模糊。 2 .脑脊液细胞学检查是诊断脑膜癌病的主要依据 ,通过免疫细胞化学的方法 ,可以准确判定转?

Objective To investigate the clinicopathologic features of the meningeal carcinoma. Methods The clinicopathologic features and symptom of the meningeal carcinoma were analyzed in 78 cases over 60 yeras old and immunocytochemistry was used. Results 1.clinical manifestation: 67 cases(85 90%)suffered from headache, and 11 cases(14 10%)dizziness. 14(17 95%) cases had fever and 5(6 41%) cases had poor vision 2.Immunocytochemistry:EMA, CK were positive and CD14, GFAP were negative in all meningeal carcinomatosis. 54 cases showed high molecule CK(+). 18 cases showed lower molecule CK(+). 6 cases showed both higher and lower molecule CK(+). 3.Followed up: In 36 cases(46 15%), primary cancers were found in lungs, 11 cases(14 10%)in gastrointestinal tract,4 cases(5 13%)in breast. Other primary cancers were found in endometrium(1 case), in ovarium(1 case) and in liver(1 case). In 24 cases(30 77%), primary cancer couldn't been found. Among the 54 cases whose primary cancers were found, 50 cases(92 59%) died from 3 to 14 months after diagnosis. In the cases no primary cancer were found, 22 cases (91 67%) died from 2 to 13 months after diagnosis. Conclusions 1.The headache and dizziness were the main symptoms. 2.The immunocytochemistry is important in the diagnosis of the meningeal carcinoma. 3.The prognosis of the cases with meningeal carcinoma was worse whether primary cancer was found or not.