Gaumann A, Marx J, Bohl J, Kommoss F, Köhler H, Tews D S
Department of Pathology, Universitätsklinik Mainz, Germany.
Pathol Res Pract. 1999;195(7):495-9. doi: 10.1016/S0344-0338(99)80053-3.
We present an occult metastatic signet-ring cell gallbladder carcinoma in a 78-year-old woman, who complained of recurrent headaches, dysarthria, and paresis of the tongue. Cranial imaging showed contrast enhancement of the basal leptomeninges, and the cerebrospinal fluid displayed clusters of adenocarcinoma cells proposed as leptomeningeal carcinomatosis of the breast, lung or gut. However, postmortem examination revealed the gallbladder as the site of the primary carcinoma with focal signet-ring cell differentiation. In patients with progressive neurologic deterioration due to leptomeningeal carcinomatosis, adenocarcinomas from the gastrointestinal and hepatic systems should be considered. It is likely that signet-ring cell carcinomas display an increased affinity to leptomeningeal spread.
我们报告了一例78岁女性隐匿性转移性印戒细胞胆囊癌，该患者主诉反复头痛、构音障碍和舌瘫。头颅影像学检查显示软脑膜基底节区强化，脑脊液中发现腺癌细胞簇，最初考虑为乳腺、肺或肠道的软脑膜癌转移。然而，尸检发现胆囊是原发性癌的部位，具有局灶性印戒细胞分化。对于因软脑膜癌转移导致进行性神经功能恶化的患者，应考虑来自胃肠道和肝脏系统的腺癌。印戒细胞癌可能更容易发生软脑膜转移。
