一例脑膜癌病误诊分析及文献回顾
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摘要
脑膜癌病是指由肺癌、胃癌、乳腺癌、结肠癌、前列腺癌、宫颈癌和黑色素瘤等多种癌瘤细胞,侵犯脑膜所导致的一种癌性脑膜病。引起的临床表现缺乏特异性,早期头颅CT或MRI检查无异常表现。临床误诊率较高。本文报道1例因头晕入院,早期误诊为"周围性眩晕"患者,最终脑脊液细胞学发现异形细胞,最终确诊为脑膜癌病的患者,以提高临床医师对该病的警觉性。
Meningeal carcinomatosis is a kind of cancer meningitis caused by invasion of meninges by lung cancer,gastric cancer, breast cancer, colon cancer, prostate cancer, cervical cancer and melanoma, etc. The clinical manifestations are not specific, and there are no abnormal findings in early cranial CT or MRI examinations. The misdiagnosis rate is high.This article reports a case of cerebrospinal fluid cytology(CSF) finding abnormal cells in a patient who was admitted to hospital with dizziness and misdiagnosed as "peripheral vertigo", to enhance clinicians′ vigilance against the disease.
Meningeal carcinomatosis is a kind of cancer meningitis caused by invasion of meninges by lung cancer,gastric cancer, breast cancer, colon cancer, prostate cancer, cervical cancer and melanoma, etc. The clinical manifestations are not specific, and there are no abnormal findings in early cranial CT or MRI examinations. The misdiagnosis rate is high.This article reports a case of cerebrospinal fluid cytology(CSF) finding abnormal cells in a patient who was admitted to hospital with dizziness and misdiagnosed as "peripheral vertigo", to enhance clinicians′ vigilance against the disease.
引文
[1]Mittica G,Senetta R,Richiardi L.Meningeal carcinomatosis underdiagnosis and overestimation:incidence in a large consecutive and unselected population of breast cancer patients[J].BMC Cancer,2015,15:1021.
[2]Elm′hadi C,Es Sbai Z,Reda Khmamouche M,et al.Meningeal carcinomatosis in breast cancer:from diagnosis to treatment[J].Rev Neurol,2017,64(7):319-324.
[3]吴熙,李峻岭,肖建平,等.甲氨蝶呤鞘内注射治疗脑膜癌病疗效和安全性的临床观察[J].中国肺癌杂志,2016,19(5):252-256.
[4]Iaconetta G,Lamaida E,Rossi A,et al.Leptomeningeal carcinomatosis:review of the literature[J].Acta Neurol(Napoli),1994,16(4):214-220.
[5]Klee GG,Tallman RD,Goellner JR,et al.Elevation of carcinoembryonic antigen in cerebrospinal fluid among patients with meningeal carcinomatosis[J].Mayo Clin Proc,1986,61(1):9-13.
[6]Bigner SH.Cerebrospinal fluid(CSF)cytology:current status and diagnostic applications[J].J Neuropathol Exp Neurol,1992,51(3):235-245.
[7]胡凤云,邵宏元,郭玲,等.脑脊液细胞学检查对脑膜癌病的诊断价值[J].中华神经科杂志,2000,33(1):6.
[8]Grovesmd.Leptomeningeal disease[J].Neurosurg Clin N Am,2011,22(1):67-68.
[9]Aragon-Ching JB,Zujewski JA.CNS metastasis:an old problem in a newguise[J].Clin Cancer Res,2007,13(6):1644-1647.
[10]Chamberlain M.Neoplastic meningitis[J].The Neurologist,2006,12:179-187.
[11]Aisner J,Aisner SC,Ostrow S,et al.Meningeal carcinomatosis from small cell carcinoma of the lung.Consequence of improved survival[J].Acta Cytol,1979,23(4):292-299.
[12]Cushman DM,Giese G,Rouhani P.Meningeal carcinomatosis in undifferentiated nasopharyngeal carcinoma:a case report[J].Ear Nose Throat J,2014,93(7):e1-e4.
[13]Chen G,Ma L,Xu M,et al.Meningeal carcinomatosis:three case-reports[J].World J Surg Oncol,2018,16(1):78.
[14]Chamberlain MC.Neoplastic meningitis[J].Semin Neurol,2004,24(4):363-374.
[15]张琴琴,何俊瑛,刘鑫,等.脑膜癌病94例临床分析[J].中国神经精神疾病杂志,2015,41(12):715-719.
[16]Liu J,Jia H,Yang Y,et al.Cerebrospinal fluid cytology and clinical analysis of 34 cases withleptomeningeal carcinomatosis[J].J Int Med Res,2009,37(6):1913-1920.
[17]尹帅.脑膜转移癌诊疗现状[J].国际肿瘤学杂志,2010,37(5):365-368.
[18]Cessot A,Blanchet B,Goldwasser F.Erlotinib treatment of meningeal carcinomatosis in lung cancer:more is better[J].Ann Oncol,2014,25(10):2093-2094.
[19]Zagouri F,Sergentanis TN,Bartsch R,et al.Intrathecal administration of trastuzumab for the treatment of meningeal carcinomatosis in HER2-positive metastatic breast cancer:a systematic review and pooled analysis[J].Breast Cancer Res Treat,2013,139(1):13-22.
[20]Kak M,Nanda R,Ramsdale EE,et al.Treatment of leptomeningeal carcinomatosis:current challenges and future opportunities[J].J Clin Neurosci,2015,22(4):632-637.
[2]Elm′hadi C,Es Sbai Z,Reda Khmamouche M,et al.Meningeal carcinomatosis in breast cancer:from diagnosis to treatment[J].Rev Neurol,2017,64(7):319-324.
[3]吴熙,李峻岭,肖建平,等.甲氨蝶呤鞘内注射治疗脑膜癌病疗效和安全性的临床观察[J].中国肺癌杂志,2016,19(5):252-256.
[4]Iaconetta G,Lamaida E,Rossi A,et al.Leptomeningeal carcinomatosis:review of the literature[J].Acta Neurol(Napoli),1994,16(4):214-220.
[5]Klee GG,Tallman RD,Goellner JR,et al.Elevation of carcinoembryonic antigen in cerebrospinal fluid among patients with meningeal carcinomatosis[J].Mayo Clin Proc,1986,61(1):9-13.
[6]Bigner SH.Cerebrospinal fluid(CSF)cytology:current status and diagnostic applications[J].J Neuropathol Exp Neurol,1992,51(3):235-245.
[7]胡凤云,邵宏元,郭玲,等.脑脊液细胞学检查对脑膜癌病的诊断价值[J].中华神经科杂志,2000,33(1):6.
[8]Grovesmd.Leptomeningeal disease[J].Neurosurg Clin N Am,2011,22(1):67-68.
[9]Aragon-Ching JB,Zujewski JA.CNS metastasis:an old problem in a newguise[J].Clin Cancer Res,2007,13(6):1644-1647.
[10]Chamberlain M.Neoplastic meningitis[J].The Neurologist,2006,12:179-187.
[11]Aisner J,Aisner SC,Ostrow S,et al.Meningeal carcinomatosis from small cell carcinoma of the lung.Consequence of improved survival[J].Acta Cytol,1979,23(4):292-299.
[12]Cushman DM,Giese G,Rouhani P.Meningeal carcinomatosis in undifferentiated nasopharyngeal carcinoma:a case report[J].Ear Nose Throat J,2014,93(7):e1-e4.
[13]Chen G,Ma L,Xu M,et al.Meningeal carcinomatosis:three case-reports[J].World J Surg Oncol,2018,16(1):78.
[14]Chamberlain MC.Neoplastic meningitis[J].Semin Neurol,2004,24(4):363-374.
[15]张琴琴,何俊瑛,刘鑫,等.脑膜癌病94例临床分析[J].中国神经精神疾病杂志,2015,41(12):715-719.
[16]Liu J,Jia H,Yang Y,et al.Cerebrospinal fluid cytology and clinical analysis of 34 cases withleptomeningeal carcinomatosis[J].J Int Med Res,2009,37(6):1913-1920.
[17]尹帅.脑膜转移癌诊疗现状[J].国际肿瘤学杂志,2010,37(5):365-368.
[18]Cessot A,Blanchet B,Goldwasser F.Erlotinib treatment of meningeal carcinomatosis in lung cancer:more is better[J].Ann Oncol,2014,25(10):2093-2094.
[19]Zagouri F,Sergentanis TN,Bartsch R,et al.Intrathecal administration of trastuzumab for the treatment of meningeal carcinomatosis in HER2-positive metastatic breast cancer:a systematic review and pooled analysis[J].Breast Cancer Res Treat,2013,139(1):13-22.
[20]Kak M,Nanda R,Ramsdale EE,et al.Treatment of leptomeningeal carcinomatosis:current challenges and future opportunities[J].J Clin Neurosci,2015,22(4):632-637.