脑膜癌病25例临床分析

目的：探讨脑膜癌病的临床特点和诊断依据。方法对25例确诊为脑膜癌病患者的临床资料及脑脊液细胞学资料进行回顾性分析。结果25例脑膜癌病患者中,临床表现为头痛24例,恶心、呕吐21例,脑膜刺激征阳性20例,视乳头水肿12例,意识障碍6例,四肢无力6例,视力减退5例,癫痫发作5例,精神症状5例,听力障碍3例,头晕3例,发热2例,颈痛1例；20例患者头颅CT/MRI均未见脑膜异常,5例行头颅MRI增强扫描可见2例脑膜强化,1例脑皮质肿胀,1例脑积水,1例小脑蚓部左侧可疑结节；腰椎穿刺脑脊液压力升高12例,蛋白升高16例,糖、氯降低14例,23例患者行脑脊液细胞学检查均发现异型细胞,17例患者行脑脊液免疫组化染色均发现转移癌；17例患者经临床及病理学确定其原发肿瘤,来源于肺癌10例（其中1例肺癌合并前颊黏膜鳞癌）、胃癌3例、贲门癌2、乳腺癌1例、可疑卵巢癌1例,8例来源未明。结论脑膜癌病为恶性肿瘤颅内转移的特殊形式,临床表现复杂,缺乏特异性,早期以颅内压升高为主；头颅MRI增强扫描对脑膜癌病诊断有一定指导意义；脑脊液细胞学检查结合免疫组化染色是脑膜癌病确诊的主要依据。

Clinical analysis of 25 cases of meningeal carcinomatosis

Objective To investigate the clinical features and diagnostic evidence of meningeal carcinomatosis （MC）. Methods The clinical data and cerebrospinal fluid（CSF） cytology data of 25 cases diagnosed as meningeal carcinomatosis were retrospectively reviewed. Results In 25 patients of MC, there were 11 men and 14 women and the mean age was （52±7.72） years old. 24 cases of patients with headache, 21 cases of patients with nausea and vomiting, meningeal irritation sign was positive in 20 cases, papilledema were found in 12 cases, disturbance of consciousness were found in 6 cases, four limbs weakness were found in 6 cases, vision loss were found in 5 cases, seizures were found in 5 cases, psychiatric symptoms were found in 5 cases, hearing-impaired were found in 3 cases, dizziness were found in 3 cases, fever were found in 2 cases, neck pain were found in 1 case. No meningeal enhancement were found in cranial CT and （or） cranial MRI scan among 20 patients, 5 patients underwent cranial MRI enhanced scan showed 2 cases of meningeal enhancement, 1 case of swelling of the cerebral cortex, 1 case of hydrocephalus and 1 case of the left cerebellar vermis suspicious nodules. CSF pressure increases in 12 cases, 16 cases of protein increase, and 14 cases of sugar and chlorine decrease. 23 patients with CSF cytology were found atypical cells, and 17 patients with CSF immunohistochemical staining were found metastatic cancer. Primary tumor source of 17 patients were found by the clinical and pathological, 10 cases were diagnosed with lung cancer （from which 1 case was mergered former buccal mucosa squamous cell carcinoma）, 3 cases were diagnosed with gastric cancer, 2 cases were diagnosed with cardia cancer, 1 case of breast cancer, 1 case of suspicious ovarian cancer, and 8 cases of unknown source. Conclusion MC is a special form of malignant brain metastases, clinical manifestations are complex but lack of specificity. The main manifestations are increased intracranial pressure in early stage. Cranial MRI enhanced scan may provide some referential value for the diagnosis of MC. CSF cytology combined with immunohistochemical staining is the main method to diagnose MC.