Pan Zhenyu, Yang Guozi, Yuan Tingting, Pang Xiaochuan, Wang Yongxiang, Qu Limei, Dong Lihua
Department of Radiotherapy, Norman Bethune First Hospital, Jilin University, 71 Xinmin Street, Changchun 130021, China.
BMC Cancer. 2014 Jun 3;14:399. doi: 10.1186/1471-2407-14-399.
Leptomeningeal metastasis, which results from metastasis of tumors to the arachnoid and pia mater, can lead to the dissemination of tumor cells throughout the subarachnoid space via the cerebral spinal fluid, and frequently with a poor prognosis. The primary tumor in adults is most often breast cancer, lung cancer, or melanoma. Although leptomeningeal metastasis due to cholangiocarcinoma has been reported, to the best of our knowledge there is no cytologically confirmed report of leptomeningeal metastasis from hepatocellular carcinoma.
We herein report a case of leptomeningeal metastasis from hepatocellular carcinoma in a 53-year-old woman with concomitant systemic metastases to the lung, bone, brain, kidney, adrenal gland, subcutaneous tissues, and abdominal pelvis. The neurological symptoms of the patient were relieved after treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy.
To our knowledge this is the first report of leptomeningeal metastasis from hepatocellular carcinoma confirmed by cytology. Treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy was effective.
软脑膜转移是由肿瘤转移至蛛网膜和软脑膜引起的，可导致肿瘤细胞通过脑脊液在整个蛛网膜下腔播散，且预后通常较差。成人的原发肿瘤最常见的是乳腺癌、肺癌或黑色素瘤。虽然已有胆管癌导致软脑膜转移的报道，但据我们所知，尚无经细胞学证实的肝细胞癌发生软脑膜转移的报道。
我们在此报告一例53岁女性肝细胞癌发生软脑膜转移的病例，该患者同时伴有肺、骨、脑、肾、肾上腺、皮下组织及腹盆腔的全身转移。患者经甲氨蝶呤脑脊髓液化疗联合全脑放疗后，神经症状得到缓解。
据我们所知，这是首例经细胞学证实的肝细胞癌软脑膜转移病例。甲氨蝶呤脑脊髓液化疗联合全脑放疗治疗有效。
