Bigner S H, Johnston W W
Acta Cytol. 1984 Jan-Feb;28(1):29-36.
Patients in whom the first indication of a neoplasm is the shedding of its cells into cerebrospinal fluid (CSF) present a challenging problem in differential diagnosis. The purposes of this study were to review the frequency and differential cytopathologic diagnosis of this event and to compare the distribution of neoplasms in these presentations with the overall distribution of CSF malignancy. From 1971 to 1980, 12,026 CSF specimens were examined at Duke University Medical Center, and malignant cells were seen in 318 specimens from 232 patients. No follow-up was available for seven patients, and review of hospital records disclosed five cases of false-positive diagnoses. In 25 of the remaining 220 patients, cytologic examination of CSF provided the first documentation of a neoplasm. The distribution of the 25 initial CSF presentations was as follows: 2 of 108 leukemia/lymphoma patients, 8 of 44 lung carcinoma patients, 1 of 12 melanoma patients, 0 of 18 breast carcinoma patients, 0 of 14 patients with miscellaneous primaries, 2 of 3 patients with adenocarcinoma of the stomach, 5 of 7 patients with unknown primary tumors and 7 of 14 patients with primary brain tumors.
肿瘤的首个迹象是其细胞脱落至脑脊液（CSF）中的患者，在鉴别诊断方面存在具有挑战性的问题。本研究的目的是回顾该事件的发生频率和细胞病理学鉴别诊断，并比较这些病例中肿瘤的分布与CSF恶性肿瘤的总体分布。1971年至1980年期间，杜克大学医学中心检查了12,026份CSF标本，在来自232例患者的318份标本中发现了恶性细胞。7例患者没有随访信息，查阅医院记录发现5例假阳性诊断病例。在其余220例患者中的25例中，CSF的细胞学检查首次记录了肿瘤。这25例最初的CSF病例分布如下：108例白血病/淋巴瘤患者中有2例，44例肺癌患者中有8例，12例黑色素瘤患者中有1例，18例乳腺癌患者中无，14例其他原发性肿瘤患者中无，3例胃腺癌患者中有2例，7例原发性肿瘤不明患者中有5例，14例原发性脑肿瘤患者中有7例。
