脑膜癌病的脑脊液细胞学与临床观察

目的研究脑膜癌病(LC)的脑脊液(CSF、)细胞学、临床及神经影像学特点。方法回顾分析16例LC。结果16例LC患者中，男6例、女10例，年龄29～69岁。亚急性起病，头痛14例，伴恶心、呕吐、眼底视乳头水肿；出现脑膜刺激征12例；双下肢无力5例，排尿困难3例；意识丧失、抽搐7例；视力减退5例，眼肌麻痹4例，听力下降1例，吞咽困难2例，偏瘫1例，多饮多尿1例。消瘦10例，低热5例。7例有癌症病史。CSF压力升高13例，CSF、常规计数白细胞升高10例，蛋白均升高，糖减低9例。CSF细胞学均见癌细胞，4例行免疫组化检查示，肿瘤细胞上皮膜抗原和细胞角蛋白阳性。临床及病理学确定来源肺癌6例、乳腺癌3例、胃癌2例、卵巢癌1例，来源未明4例。结论LC可作为首发症状和主要症状而缺少肿瘤原发灶表现。表现为亚急性脑膜炎，进行性颅内压升高，常合并多脑神经和脊髓神经根损害。CSF细胞学是确诊LC主要方法，结合免疫细胞化学方法对确诊有重要帮助。

Cerebrospinal Fluid Cytology and Clinical Observation of Leptomeningeal Carcinomatosis

Objective To observe the clinical characteristics of the cerebrospinal fluid (CSF) cytology in leptomeningeal carcinomatosis (LC). Methods 16 patients with LC were retrospectively reviewed in the hospital, diagnosed by CSF cytology. Results Most patients presented with subacute progressive headache, sign of meningeal irritation and intracranial hypertension. Multiple cranial never paralysis and lesion in the nerve roots of lower spinal segments are common. Gadolinium-enhanced magnetic resonance imaging (MRI) showed ~leptomeningeal enhancement in 5 cases. The CSF changes include the increased white blood cell count, elevated protein level, lowered glucose and/or chloride level. The malignant cells were identified in all CSF specimens. The tumor cells are positive with epithelial membrane antigen and/or cytokeratin immunostain.The original sites of primary tumor in LC including lung cancer (6 cases) breast cancer (3 cases), gastric cancer (2 cases), ovary cancer (1 cases) and tumor of unknown origin (4 cases). Conclusions The diagnosis of LC is often difficult and requires the demonstration of malignant cells in the CSF cytology. Immunocytochemistry is of great help in the diagnosis of LC. The sedimentation preparations of CSF are suitable for immunocytochemical studies.