疑似颅内静脉窦血栓形成的脑膜癌一例
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摘要
目的探讨脑膜癌病(MC)的临床表现和影像学特点,以提高对该病的认识。方法报道1例疑似静脉窦血栓形成(CVST)的MC病例。结果患者男性,62岁,主因头痛恶心呕吐5d,发作性抽搐2d入院,临床表现为头痛、恶心呕吐,头痛进行性加重,头痛发作时伴双侧瞳孔不等大,右侧直径2mm,左侧直径4mm,对光反射未引出,头痛缓解双侧瞳孔可自行恢复。头颅MRV示左侧横窦、左侧乙状窦未见显影,不除外患者静脉窦血栓形成,给予抗凝、绛纤、脱水降颅压治疗,头痛未见好转。进一步查脑血管造影(DSA)提示未见静脉窦血栓形成,脑脊液(CSF)细胞学提示散在或小堆分布异常细胞,该细胞体积大,圆形,核染色质较粗,核仁隐现不一,核质比大,胞浆染蓝色、深蓝色、灰红蓝色,有空泡样改变,部分细胞胞浆边缘呈裙边样,可见双核异常细胞及核分裂象。头颅磁共振成像(MRI)增强示部分脑膜强化,故临床诊断为MC。结论本例MC患者以头痛、恶心呕吐起病,视乳头边界模糊,头颅MRV不除外静脉窦血栓形成,因而早期容易误诊,及早行腰椎穿刺CSF细胞学检查有助于MC的早期诊断。
Objective To explore the clinical manifestations, imaging findings of the meningeal carcinomatosis(MC), in order to improve the understanding of the disease. Method A case of MC of suspected venous sinus thrombosis(CVST) was reported. Results The male patient was 62 years old, mainly due to headache, nausea and vomiting for 5 days, and seizures for 2 days. The clinical manifestations were headache, nausea and vomiting, and the headache was progressively aggravated. During headache attack, bilateral pupil is unequal,right diameter was 2 mm and left was 4 mm, light reflex is not induced, bilateral pupil can recover by itself when the headache delayed release. The intracranial MC venograph showed that left transverse sinus and left sigmoid sinus were not developed. While the treatment anticoagulant, dehydration and intracranial pressure were given, headache has not been improved. Further examination of cerebral digital subtraction angiography(DSA) showed that no venous sinus thrombosis was found, cerebrospinal fluid(CSF) cytology showed there were scattered or distributed in a small pile cells,the size of which was big, nuclear chromatin was thicker, nucleolus was indistinct, nucleus to cytoplasm ratio was large, and cytoplasm was blue, dark blue, reddish blue, free bubble changed, part of the cytoplasmic edges of the cells were skirt sample, dikaryotic cells and mitotic figures could be seen.The head magnetic resonance imaging enhancement showed partial meningeal enhanced, The patient was diagnosed of MC. Conclusion This patient with onset of headache, appeared only cranial pressure and meningeal stimulation at the early stage, and intracranial magnetic resonance venography showed venous sinus thrombosis could't be excluded, therefore, misdiagnosed as venous sinus thrombosis, so early initiation of lumbar puncture CSF cytology maybe helpful in the early diagnosis of MC.
Objective To explore the clinical manifestations, imaging findings of the meningeal carcinomatosis(MC), in order to improve the understanding of the disease. Method A case of MC of suspected venous sinus thrombosis(CVST) was reported. Results The male patient was 62 years old, mainly due to headache, nausea and vomiting for 5 days, and seizures for 2 days. The clinical manifestations were headache, nausea and vomiting, and the headache was progressively aggravated. During headache attack, bilateral pupil is unequal,right diameter was 2 mm and left was 4 mm, light reflex is not induced, bilateral pupil can recover by itself when the headache delayed release. The intracranial MC venograph showed that left transverse sinus and left sigmoid sinus were not developed. While the treatment anticoagulant, dehydration and intracranial pressure were given, headache has not been improved. Further examination of cerebral digital subtraction angiography(DSA) showed that no venous sinus thrombosis was found, cerebrospinal fluid(CSF) cytology showed there were scattered or distributed in a small pile cells,the size of which was big, nuclear chromatin was thicker, nucleolus was indistinct, nucleus to cytoplasm ratio was large, and cytoplasm was blue, dark blue, reddish blue, free bubble changed, part of the cytoplasmic edges of the cells were skirt sample, dikaryotic cells and mitotic figures could be seen.The head magnetic resonance imaging enhancement showed partial meningeal enhanced, The patient was diagnosed of MC. Conclusion This patient with onset of headache, appeared only cranial pressure and meningeal stimulation at the early stage, and intracranial magnetic resonance venography showed venous sinus thrombosis could't be excluded, therefore, misdiagnosed as venous sinus thrombosis, so early initiation of lumbar puncture CSF cytology maybe helpful in the early diagnosis of MC.
引文
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[2]Pavlidis N.The diagnostic and therapeutic management of leptomeningeal carcinomatosis[J].Ann Oncol,2004,15(Suppl4):285-291.
[3]Duan H,Li M,Sun X.Clinical features of patients with carcinomatous meningitis in the Chinese population:report of 4 cases and review of the literature[J].Turk Neurosurg,2014,24(1):13-18.
[4]Chuang TY,Yu CJ,Shih,JY,et al.Cytologically proven meningeal carcinomatosis in patients with lung cancer:clinical observation of 34cases[J].J Formos Med Assoc,2008,107(11):851-856.
[5]Balm M,Hammack J.Leptomeningeal carcinomatosis.Presenting features and prognostic factors.Arch Neurol,1996,53(7):626-628.
[6]Gdovinova Z,Feketeova E,Szilasiova J,et al.Meningeal carcinomatosis as the first manifestation of malignant carcinomatosis[J].Bratisl Lek Listy,2009,110(8):490-495.
[7]Chamberlain MC.Leptomeningeal metastasis[J].Curr Opin Oncol,2010,(22):627-635.
[8]Ma L,Yu S,Cai Y,et al.MR imaging of meningeal carcinomatosis by systemic malignancy[J].Chin Med Sci,2003,18(1):36-40.
[9]刘青蕊,韩颖,梅风君,等.脑膜转移瘤临床特征及脑脊液细胞学分析[J].脑与神经疾病杂志,2010,18(2):143-145.
[10]Lavrador JP,Simag N,Oliveira E,et al.Intratechal chemotherapy treatment through an ommaya reservoir catheter for meningeal carcinomatosis:A single-Centre experience[J].Acta Med Port,2016,29(7-8):456-460.
[11]王惠杰,张湘茹.脑膜转移瘤22例的临床诊治及预后[J].中国癌症杂志,2004,14(4):351-353.