肺腺癌-脑膜瘤内转移伴脑膜癌病

doi:10.3969/j.issn.1672-6731.2020.04.013

中国现代神经疾病杂志 ›› 2020, Vol. 20 ›› Issue (4): 330-337. doi: 10.3969/j.issn.1672-6731.2020.04.013

2 肺腺癌-脑膜瘤内转移伴脑膜癌病

范冲竹¹, 李海南¹, 许绍强², 邓达标³, 张振斌¹, 杨丽¹, 李智⁴

1. 510510 广州, 广东三九脑科医院病理科;
2. 510510 广州, 广东三九脑科医院医学检验中心;
3. 510510 广州, 广东三九脑科医院影像中心;
4. 510080 广州, 广东省人民医院病理科

收稿日期:2019-12-17 出版日期:2020-04-25 发布日期:2020-04-24
通讯作者: 李智,Email:lizhi@mail.sysu.edu.cn
基金资助:
广东省自然科学基金资助项目（项目编号：2017A030313779）；广东省医学科学技术研究基金资助项目（项目编号：A2019315）

Pulmonary adenocarcinoma-to-meningioma metastasis with meningeal carcinomatosis

FAN Chong-zhu¹, LI Hai-nan¹, XU Shao-qiang², DENG Da-biao³, ZHANG Zhen-bin¹, YANG Li¹, LI Zhi⁴

1 Department of Pathology, Guangdong 999 Brain Hospital, Guangzhou 510510, Guangdong, China;
2 Department of Clinical Laboratory, Guangdong 999 Brain Hospital, Guangzhou 510510, Guangdong, China;
3 Department of Medical Imaging, Guangdong 999 Brain Hospital, Guangzhou 510510, Guangdong, China;
4 Department of Pathology, Guangdong Provincial People's Hospital, Guangzhou 510080, Guangdong, China

Received:2019-12-17 Online:2020-04-25 Published:2020-04-24
Supported by:
This study was supported by the Natural Science Foundation of Guangdong Province (No. 2017A030313779) and Medical Scientific Research Foundation of Guangdong Province (No. A2019315).

摘要/Abstract

摘要：

目的探讨肺腺癌-脑膜瘤内转移伴脑膜癌病的临床病理学特征，以减少此类罕见疾病漏诊率。方法与结果 女性患者，58岁。因反复头痛4年，加重伴头晕、呕吐2个月入院。头部MRI显示左侧岩骨尖跨中后颅窝（以中后颅窝为主）占位性病变。显微镜下可见肿瘤组织主要为脑膜皮细胞型脑膜瘤成分，另见蛛网膜表面腺癌细胞种植及脑膜瘤内小灶腺癌团巢；脑脊液细胞学可见异形肿瘤细胞；脑膜瘤成分主要表达孕激素受体、生长抑素受体2，Ki-67抗原标记指数约为3%；腺癌成分表达细胞角蛋白、细胞角蛋白7、甲状腺转录因子-1和天冬氨酸蛋白酶，Ki-67抗原标记指数约30%；上皮膜抗原两种肿瘤成分均表达阳性。病理诊断：肺腺癌-脑膜瘤内转移伴脑膜癌病。结论肺腺癌-脑膜瘤内转移临床罕见，目前为止国内外共报道20例病例，好发于老年人，以女性居多，预后较差。确诊主要依靠组织病理学证据，但仍可有漏诊病例，需结合患者临床表现、影像学所见，以及脑脊液细胞学检测结果进行多学科联合诊断方能做出正确诊断。

关键词: 脑膜癌病, 肺肿瘤, 脑膜瘤, 免疫组织化学

Abstract:

Objective To investigate the clinicopathological features of pulmonary adenocarcinoma-to-meningioma metastasis with meningeal carcinomatosis, and to reduce the rate of missed diagnosis of this disease. Methods and Results A 58-year-old female was admitted to hospital due to repeated headaches for 4 years and increased dizziness and vomiting for 2 months. Head MRI showed a space-occupying lesion in left apical petrous cross middle posterior fossa (mainly in the posterior fossa). Microscopy showed the tumor was mainly composed of meningothelial meningioma. In addition, the implantation of adenocarcinoma cells on the surface of arachnoid, and the small tumor adenocarcinoma nests in the meningioma were found. The cerebrospinal fluid cytology found heterotypic tumor cells. Immunohistochemical staining showed meningioma components expressed progesterone receptor (PR), somatostatin receptor 2 (SSTR2), Ki-67 proliferation index was 3%; adenocarcinoma components express cytokeratin (CK), cytokeratin 7 (CK7), thyroid transcription factor-1 (TTF-1), aspartic protease A (Napsin A), Ki-67 proliferation index was 30%. Epithelial membrane antigen (EMA) was stained of two components. Final pathological diagnosis was pulmonary adenocarcinoma-to-meningioma metastasis with meningeal carcinomatosis. Conclusions Pulmonary adenocarcinoma-to-meningoma metastasis is uncommon, So far, there are 20 cases reported. It is common in the elderly, mostly in women, with poor prognosis. Accurate diagnosis depends on histopathological, and should be combined with clinical, imaging, cerebrospinal fluid cytology, multidisciplinary diagnosis can avoid missed diagnosis.

Key words: Meningeal carcinomatosis, Lung neoplasms, Meningioma, Immunohistochemistry

范冲竹, 李海南, 许绍强, 邓达标, 张振斌, 杨丽, 李智. 肺腺癌-脑膜瘤内转移伴脑膜癌病[J]. 中国现代神经疾病杂志, 2020, 20(4): 330-337.

FAN Chong-zhu, LI Hai-nan, XU Shao-qiang, DENG Da-biao, ZHANG Zhen-bin, YANG Li, LI Zhi. Pulmonary adenocarcinoma-to-meningioma metastasis with meningeal carcinomatosis[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(4): 330-337.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I4/330

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