Suresh Pooja K, Kini Jyoti Ramanath, Basavaiah Sridevi H, Kini Hema, Khadilkar Urmila N, Chakraborti Shrijeet
Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India.
Department of Cellular Pathology, Leighton Hospital, Crewe, Cheshire, United Kingdom.
J Cytol. 2018 Oct-Dec;35(4):255-259. doi: 10.4103/JOC.JOC_167_17.
Neoplastic involvement of cerebrospinal fluid (CSF) secondary to known or unknown primaries elsewhere is a poor prognostic factor and is equivalent to stage IV disease.
The aim of the study is to analyse the cytological features of neoplastic meningitis in a tertiary care center.
A retrospective study of 400 consecutive CSF samples was done in the cytology laboratory of our hospital. The fluid obtained by spinal tap was sent for microbiological, biochemical and cytological evaluation. Smears that showed the presence of malignant cells were included in this study.
Out of 400 cases, 36 (9%) showed neoplastic meningitis. Of which, 13 cases (36%) revealed leukemic infiltration, 2 (6%) lymphomatous infiltration and 21 (58%) carcinomatous meningitis. The leukemia cases included seven cases of acute lymphoblastic leukemia and six cases of acute myeloid leukemia. Among the carcinomatous meningitis cases, eight were metastasis from carcinoma breast, six from lung carcinoma and one each from malignancies of gallbladder, stomach and retinoblastoma. Four cases were metastatic adenocarcinoma from unknown primary. Pleocytosis was a significant finding seen in 58% cases ( = 21). Elevated protein and hypoglychorrhachia was noted in 68% cases ( = 18).
A combined diagnostic approach including biochemical, microbiological and pathological evaluation was useful in eliminating infectious meningitis and confirming neoplastic meningitis in these cases. Cytology should be performed on cerebrospinal specimens from all patients with known or suspected malignancy with meningismus. Detection of malignant cells on cytological examination of CSF is the diagnostic gold standard for neoplastic meningitis.
继发于其他部位已知或未知原发肿瘤的脑脊液（CSF）肿瘤累及是一个不良预后因素，等同于IV期疾病。
本研究旨在分析一家三级医疗中心肿瘤性脑膜炎的细胞学特征。
在我院细胞学实验室对400份连续的脑脊液样本进行回顾性研究。通过腰椎穿刺获取的脑脊液样本送检进行微生物学、生物化学和细胞学评估。本研究纳入显示存在恶性细胞的涂片。
400例病例中，36例（9%）显示为肿瘤性脑膜炎。其中，13例（36%）为白血病浸润，2例（6%）为淋巴瘤浸润，21例（58%）为癌性脑膜炎。白血病病例包括7例急性淋巴细胞白血病和6例急性髓细胞白血病。在癌性脑膜炎病例中，8例为乳腺癌转移，6例为肺癌转移，1例分别来自胆囊、胃和视网膜母细胞瘤的恶性肿瘤。4例为原发部位不明的转移性腺癌。58%的病例（n = 21）出现显著的细胞增多。68%的病例（n = 18）出现蛋白升高和脑脊液低糖。
包括生物化学、微生物学和病理学评估的联合诊断方法有助于排除感染性脑膜炎并确诊这些病例中的肿瘤性脑膜炎。对于所有有脑膜刺激征且已知或疑似恶性肿瘤的患者，均应进行脑脊液细胞学检查。脑脊液细胞学检查发现恶性细胞是肿瘤性脑膜炎的诊断金标准。
