Lardinois Benjamin, Miller Laurence, Randazzo Adrien, Laurent Terry, Debois Régis, Henry Stéphanie
Department of Laboratory, CHU UCL Namur Site de Sainte-Elisabeth, Université Catholique de Louvain, Namur, Belgium.
Department of Oncology, CHU UCL Namur Site de Sainte-Elisabeth, Université Catholique de Louvain, Namur, Belgium.
Case Rep Oncol. 2021 Aug 18;14(2):1248-1253. doi: 10.1159/000518314. eCollection 2021 May-Aug.
In the cerebrospinal fluid (CSF), the demonstration of malignant cells by cytological examination is currently the gold standard for the diagnosis of leptomeningeal carcinomatosis (LC). However, a positive cytology is observed in only 50-60% of patients with LC and highly dependent on pre-analytical factors. The hematology laboratory could provide an immediate and accurate diagnosis, but diagnostic sensitivity is not always optimized once the sample is received. We hereby report a 49-year-old woman with a 3-year grade III invasive ductal carcinoma who was admitted to the emergency department due to headaches, nausea, and vomiting. The CSF revealed pleocytosis with suspicious high fluorescent cells on the hematology analyzer concomitantly with biochemical alterations. Cytomorphological examination confirmed tumor cells, thus diagnosing a leptomeningeal metastasis of her breast cancer. The patient was eventually transferred to palliative care. Cytological examination is a valuable tool for a rapid diagnosis of LC if diagnostic performance is optimized. In addition to repeated CSF collections with a sufficient volume (5-10 mL), this could be reached by processing the CSF as soon as possible, taking into account the fluorescence information from the analyzer, proceeding systematically to microscopic examination even with normal CSF white blood cell count, and providing quality improvement of the staff to identify malignant cells.
在脑脊液（CSF）中，通过细胞学检查发现恶性细胞是目前诊断软脑膜癌病（LC）的金标准。然而，只有50%-60%的LC患者细胞学检查呈阳性，且高度依赖于分析前因素。血液学实验室可以提供即时且准确的诊断，但一旦收到样本，诊断敏感性并不总是能达到最佳状态。我们在此报告一名49岁女性，患有3年III级浸润性导管癌，因头痛、恶心和呕吐入住急诊科。脑脊液显示细胞增多，血液分析仪上出现可疑的高荧光细胞，同时伴有生化改变。细胞形态学检查证实为肿瘤细胞，从而诊断出她的乳腺癌软脑膜转移。该患者最终被转入姑息治疗。如果优化诊断性能，细胞学检查是快速诊断LC的重要工具。除了重复采集足够量（5-10 mL）的脑脊液外，还可以通过尽快处理脑脊液、考虑分析仪的荧光信息、即使脑脊液白细胞计数正常也系统地进行显微镜检查以及提高工作人员识别恶性细胞的能力来实现。
