脑膜癌病的临床与病理特点

目的探讨脑膜癌病的临床与病理特点。方法回顾性分析142例脑膜癌病患者的临床及脑脊液(CSF)细胞学资料和免疫细胞化学标记结果。结果本组患者临床特点:头痛123例(86.62%),头晕19例(13.38%),发热26例(18.31%),视物模糊10例(7.04%)。CSF检查及免疫标记:全部患者CSF中均发现癌细胞;癌细胞上皮膜抗原(EMA)( ),细胞角蛋白(CK)( ),CD14(-),胶质纤维酸性蛋白(GFAP)(-)。其中99例(69.72%)CK低分子( )、高分子(-),诊断为转移性腺癌;33例(23.24%)CK高分子( )、CK低分子(-),诊断为转移性鳞癌;10例(7.04%)CK高分子( )、CK低分子( ),考虑为腺鳞癌。105例找到原发灶,其中67例(47.18%)确诊为肺癌;23例(16.20%)在消化道内找到原发灶;9例(6.34%)为乳腺癌;子宫内膜癌、卵巢癌、肝癌各1例。另有37例(26.06%)未找到原发灶。诊断明确的患者中,15例失访,另90例中有82例(91.11%)于确诊后3～14个月死亡。未找到原发灶的患者中,有6例失访,另31例中有28例(90.32%)在确诊后2～13个月内死亡。结论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。CSF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,可以确定转移癌细胞。脑膜癌病患者预后较差。

Clinical and pathological features of meningeal carcinoma

Objective To investigate the clinical and pathological features of meningeal carcinoma.Methods The clinical,cerebrospinal fluid(CSF)and immunocytochemistry data of 142 patients with meningeal carcinoma were analysis retrospectively.Results Clinical manifestation:headache were found in 123 cases(86.62%),and dizziness were found in 19 cases(13.38%).26 cases(18.31%)had fever and 10 cases(7.04%)had poor vision.CSF and immunocytochemistry:in all cases,EMA,CK were positive and CD14,GFAP were negative in all meningeal carcinomatosis.99 cases(69.72%)showed low molecule CK( )and high molecule CK(-).These were adenocarcinoma.33 cases(23.24%)showed high molecule CK( )and low molecule CK(-).These were squamous cell carcinoma.10 cases(7.04%)showed both high and low molecule CK( ).These were adenocarcinoma and squamous cell carcinoma.In 67 cases(47.18%),primary cancer were found in lungs.Tumors were found in gastrointestinal tract in 23 cases(16.20%),and in breast in 9 cases(6.34%).Other primary cancers were found in endomertrium(1 case),in ovarium(1 case)and in liver(1 case).In 37 cases(26.06%),primary cancer couldn't been found.Among the 105 cases which primary cancer were found,15 cases were drawn out.In other 90 cases,82(91.11%)died from 3 to 14 months after diagnosis.In the cases no primary cancer were found,6 cases were drawn out.In other 31 cases,28(90.32%)died from 2 to 13 months after diagnosis although primary tumor was not found.Conclusions The headache and dizziness are the main symptom.The immunocytochemistry are important in the diagnosis of the meningeal carcinoma.The prognosis of the cases with meningeal carcinoma is serious whatever found or not found primary cancer.