Cerebrospinal fluid abnormalities in meningeosis neoplastica: a retrospective 12-year analysis.
Cerebrospinal fluid abnormalities in meningeosis neoplastica: a retrospective 12-year analysis.
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DOI：
10.1186/s12987-017-0057-2
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发表时间：
2017-03-28
影响因子：
7.3
通讯作者：
Nau R
中科院分区：
文献类型：
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作者：
Djukic M;Trimmel R;Nagel I;Spreer A;Lange P;Stadelmann C;Nau R
肿瘤性脑膜炎是肿瘤细胞在蛛网膜下腔的扩散性转移。虽然在1870年首次认识到，在这种情况下的脑脊液（CSF）成分的系统调查是稀缺的。重新评价了2001年至2012年在哥廷根大学临床神经化学实验室分析的常规CSF样本。CSF中含有恶性细胞的患者被纳入本研究。确定了CSF中含有恶性细胞的患者（n = 132，年龄59.1 ± 29.1，58%为女性）。最常见的原发肿瘤是乳腺癌（32.6%），其次是肺癌（25.0%）和血液系统恶性肿瘤（21.2%）。临床表现以颅神经损害（41.7%）、精神异常（32.6%）和下肢神经根损害（20.5%）为主。CSF细胞计数范围为0至4692个细胞/μl（中位数为4个细胞/μl），50%的患者升高。脑脊液与血清白蛋白比值异常者占69.4%。其范围为1.8至330 x 10-3（中位数为17.5 x 10-3）。总CSF蛋白范围为166 - 15，840 mg/l（中位数1012 mg/l）。65.2%的患者CSF乳酸盐升高（>2.4 mmol/l）[3.6 mmol/l（1.3/15.6 mmol/l）;中位数（最小值/最大值）]。50%的患者CSF乳酸≥3.5 mmol/l。脑脊液细胞计数与脑脊液乳酸水平和蛋白含量呈显著正相关。118例脑脊液标本中有56例（47.5%）铁蛋白升高，65例癌患者中有25例（38.5%）鞘内检测到癌胚抗原（CEA）。在52.7%的CSF样本中发现粒细胞。粒细胞和淋巴细胞的百分比在细胞计数升高的样品中较高。在约50%的肿瘤性脑膜炎CSF样本中，CSF细胞计数未升高。当仅对细胞计数升高的CSF样本进行细胞学分析时，可能会错过诊断。肿瘤性脑膜炎患者脑脊液乳酸盐和蛋白质以及脑脊液与血清白蛋白的比值经常升高。肿瘤性脑膜炎和中枢神经系统感染，特别是结核性或真菌性脑膜炎的鉴别诊断是困难的。
Meningeosis neoplastica is a diffuse metastatic spread of tumor cells in the subarachnoid space. Although first recognized in 1870, systematic investigations regarding cerebrospinal fluid (CSF) constituents in this condition are scarce. Routine CSF samples analyzed from 2001 to 2012 at the Laboratory of Clinical Neurochemistry, University of Göttingen, were re-evaluated. Patients, whose CSF contained malignant cells were included in this study. Patients (n = 132, age 59.1 ± 29.1, 58% women) were identified, whose CSF contained malignant cells. The most frequent primary tumor was breast cancer (32.6%), followed by lung cancer (25.0%) and hematologic malignancies (21.2%). The most frequent clinical symptoms were affections of cranial nerves (41.7%), psychiatric abmormalities (32.6%) and radicular lesions of the lower extremities (20.5%). CSF cell counts ranged from 0 to 4692 cells/μl (median 4 cells/μl) and were elevated in 50%. The CSF-to-serum albumin ratio was abnormal in 69.4%. It ranged from 1.8 to 330 x 10-3 (median 17.5 x 10-3). Total CSF protein ranged from 166 to 15,840 mg/l (median 1012 mg/l). CSF lactate was elevated (>2.4 mmol/l) in 65.2% [3.6 mmol/l (1.3/15.6 mmol/l); median (minimum/maximum)]. In 50% of all patients CSF lactate was ≥3.5 mmol/l. The CSF cell counts correlated significantly with the CSF lactate levels and the CSF protein contents. In 56 of 118 CSF samples (47.5%) ferritin was elevated, and in 25 of 65 carcinoma patients (38.5%) an intrathecal production of carcinoembryonic antigen (CEA) was detected. Granulocytes were found in 52.7% of the CSF samples. The percentages of granulocytes and lymphocytes were higher in samples with an elevated cell count. In approximately 50% of CSF samples with meningeosis neoplastica the CSF cell count is not elevated. Diagnosis may be missed when only CSF samples with elevated cell counts are subjected to cytological analysis. CSF lactate and protein and the CSF-to-serum albumin ratio are frequently increased in meningeosis neoplastica. The differential diagnosis between meningeosis neoplastica and central nervous infections, in particular tuberculous or fungal meningitis, can be difficult.