摘要：

目的 总结4例脑膜癌病患者脑脊液细胞学和影像学特点，以提高其诊断与治疗水平。方法 回顾分析2016年2月至2019年1月收治的经临床及液基薄片法脑脊液细胞学确诊的4例脑膜癌病患者的临床表现、影像学和脑脊液细胞学特点。结果 4例患者均有肿瘤病史（肺癌2例、胃癌1例、乳腺癌1例），无一例发现MRI明显脑膜强化征，PET-CT亦无阳性所见（1例）。腰椎穿刺脑脊液检查，颅内压升高3例、白细胞计数增加2例、葡萄糖水平降低2例、蛋白定量升高3例；液基薄片法脑脊液细胞学检测均发现异型性肿瘤细胞。4例患者出院后，1例继续治疗并随访至今，其余3例确诊后1~12个月死亡。结论 脑膜癌病患者的影像学表现不典型，临床病史可协助诊断；脑脊液细胞学检测对明确诊断具有重要意义

关键词: 脑膜癌病, 脑脊髓液, 细胞学技术

Abstract:

Objective The cerebrospinal fluid (CSF) cytological and imaging features in 4 patients with meningeal carcinomatosis (MC) were investigated to assist with the diagnosis and improve the treatment of the disease. Methods A retrospective analysis was utilized to investigate the clinical manifestations, imaging, and liquid-based CSF cytology of 4 patients with MC by using CSF cytology, all of whom were treated at the Department of Neurology at Wuhan No.1 Hospital from February 2016 to January 2019. Results Four patients (2 males and 2 females) with an average age of (60.00 ±15.85) years old had a symptom of headache, 2 of whom had a symptom of slow response. Among 4 patients, all had a history of tumor disease; 2 had a history of lung cancer; one had a history of gastric cancer; one had a history of breast cancer. Four patients underwent lumbar puncture. Two patients had increased white blood cell count, and the other 2 demonstrated decreased glucose levels. Three patients had elevated protein levels. There were 3 cases with increased intracranial pressure (ICP) and 4 cases with atypical cells, as indicated by liquid-based CSF cytology. However, no apparent meningeal enhancement was found in 4 patients. One of the patients had a negative PET-CT. All patients had been receiving or received symptomatic treatment during hospitalization. Post hospital discharge, one patient had been in treatment, and the other 3 patients died within one month to one year after diagnosis. Conclusions The imaging findings of patients with MC were atypical. The clinical history of patients with MC can help with diagnosis. The CSF cytology on these patients has considerable significance to diagnosis.

Key words: Meningeal carcinomatosis, Cerebrospinal fluid, Cytological techniques