Xing Lidan, Liu Jiajia, Yan Haiyang, Chen Jing, Gao Lingling, Afzal Muhammad Zubair, Hida Toyoaki, Zhao Shuai, Sun Jingna
Department of Clinical Laboratory, The First Hospital of Hebei Medical University, Shijiazhuang, China.
Hebei Innovation Center of Clinical Medical Laboratory Technology, Shijiazhuang, China.
Transl Lung Cancer Res. 2025 Feb 28;14(2):607-613. doi: 10.21037/tlcr-2025-37. Epub 2025 Feb 27.
The examination of cerebrospinal fluid (CSF) cytology holds significant value in the field of neuropathology, serving as a key diagnostic tool for clinical physicians in completing differential diagnosis and clinical assessment. Particularly in the context of infectious diseases affecting the central nervous system (CNS), cerebrovascular diseases, brain tumors, meningeal carcinoma, and immune-related disorders, this examination is critical to facilitating accurate diagnoses and distinguishing between various clinical conditions.
A 57-year-old Han Chinese male was admitted to The First Hospital of Hebei Medical University for psychiatric symptoms. A series of diagnostic tests were sequentially conducted on the patient, including routine CSF examination, CSF biochemical analysis, test for autoimmune encephalitis antibodies and paraneoplastic syndrome autoantibodies, pathogen-targeted sequencing, cytokine analysis via flow cytometry, tumor marker tests, positron emission tomography-computed tomography, and cranial magnetic resonance imaging (MRI). The results showed an increase in CSF white blood cell count, CSF protein, and serum carcinoembryonic antigen. In conjunction with cranial MRI revealing multiple intracranial nodular abnormal signals, these can serve as effective evidence to aid in diagnosis. However, the definitive diagnosis of meningeal carcinomatosis (MC) ultimately depends on the cytological identification of atypical cells in the CSF. Given the patient's history of lung cancer, the final diagnosis was leptomeningeal metastasis from lung cancer, which belongs to the type of CNS metastatic carcinoma in MC.
In this case, the cytological identification of atypical cells in the CSF confirmed the diagnosis of MC.
脑脊液（CSF）细胞学检查在神经病理学领域具有重要价值，是临床医生完成鉴别诊断和临床评估的关键诊断工具。特别是在影响中枢神经系统（CNS）的传染病、脑血管疾病、脑肿瘤、脑膜癌和免疫相关疾病的背景下，这项检查对于促进准确诊断和区分各种临床情况至关重要。
一名57岁的汉族男性因精神症状入住河北医科大学第一医院。对该患者依次进行了一系列诊断检查，包括脑脊液常规检查、脑脊液生化分析、自身免疫性脑炎抗体和副肿瘤综合征自身抗体检测、病原体靶向测序、流式细胞术细胞因子分析、肿瘤标志物检测、正电子发射断层扫描-计算机断层扫描以及头颅磁共振成像（MRI）。结果显示脑脊液白细胞计数、脑脊液蛋白和血清癌胚抗原升高。结合头颅MRI显示多个颅内结节状异常信号，这些可作为辅助诊断的有效证据。然而，脑膜癌病（MC）的明确诊断最终取决于脑脊液中异型细胞的细胞学鉴定。鉴于患者有肺癌病史，最终诊断为肺癌软脑膜转移，属于MC中的中枢神经系统转移癌类型。
在本病例中，脑脊液中异型细胞的细胞学鉴定确诊了MC。
