Versluis J M, Brandsma D, van den Berg J G, Tesselaar Met
Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
BMJ Case Rep. 2018 Nov 3;2018:bcr-2018-226557. doi: 10.1136/bcr-2018-226557.
A 73-year-old man, without any medical history, had presented with dark urine and pale stool without pain. Diagnostic imaging revealed a tumour in the pancreas with liver metastases. Histopathological examination showed a well-differentiated pancreatic neuroendocrine tumour. After a stable 2.5 years on everolimus, progression of the liver metastases was seen and a switch was made to chemotherapy. Three months later, he developed progressive spinal neurological symptoms. MRI of the spine and brain revealed leptomeningeal contrast-enhancing lesions. Cytopathological examination of the cerebrospinal fluid showed malignant epithelial cells compatible with well-differentiated neuroendocrine tumour. Epithelial cell-adhesion molecule-based flow cytometry of the cerebrospinal fluid confirmed the presence of epithelial tumour cells. Based on these results, the diagnosis of leptomeningeal metastases of an originally well-differentiated neuroendocrine tumour of the pancreas was made.
一名73岁男性，无任何病史，出现无痛性深色尿液和浅色粪便。诊断性影像学检查显示胰腺有肿瘤并伴有肝转移。组织病理学检查显示为高分化胰腺神经内分泌肿瘤。使用依维莫司稳定治疗2.5年后，出现肝转移进展，遂改用化疗。三个月后，他出现进行性脊髓神经症状。脊柱和脑部MRI显示软脑膜有强化病变。脑脊液细胞病理学检查显示恶性上皮细胞，与高分化神经内分泌肿瘤相符。基于上皮细胞粘附分子的脑脊液流式细胞术证实存在上皮肿瘤细胞。根据这些结果，诊断为原发性高分化胰腺神经内分泌肿瘤的软脑膜转移。
