To Investigate The Value Of CK、CK7、PLUNC In The Diagnosis And Treatment Of Meningeal Carcinomatosis

Objective: Meningeal carcinomatosis (MC) is a devastating complicationof the malignancy from all over the body focal or diffuse infiltration of theleptomeninges/spinal meninges/subarachnoid space via blood/lymphaticvessel. Complex and varied clinical manifestations, imaging findings ofmeningeal carcinomatosis nonspecific, lead to the diagnosis of meningealcarcinomatosis is relatively difficult. The diagnosis of cerebrospinal fluid(CSF) is the main method of cell morphology, the sensitivity is about50%.Due to Immunocytochemistry staining clear background, easy to identifycancer cells, the specimen is easy to save. In recent years someone put forwardusing immunocytochemistry to increase the diagnostic sensitivity and promptprimary tumors. For better treatment options for patients with solid tumormetastasis MC is intrathecal injection of methotrexate. The methods ofmonitoring the efficacy of treatment were clinical nerve function、CSFcytology and monitoring CSF levels of tumor markers etc. This study chooseCK (cytokerins)and CK7(cytokeratin7), PLUNC (palatal nasal lungspecificity protein) to detect express results in cerebrospinal fluid of MC usingmmunocytochemistry staining, to understand the value of the three kinds ofprotein in improving the MC diagnostic sensitivity and specificity and promptvalue in the original site; And using enzyme-linked immunoassay (ELISA)watch CK, PLUNC expression levels in CSF and level changes before andafter treatment, coupled with clinical neural function and CSF cytologychanges, and evaluate therapeutic effect.Methods： Subjects was58patients with diagnosis of meningealcarcinomatosisto in the second hospital, hebei medical university neurology inMarch2010to December2012,primary focal for25cases of lung cancer, cardia carcinoma3cases, gastric cancer7cases,5cases of breast cancer,genital tumor in2cases, primary focal unknown16cases; Treated withintrathecal injection of methotrexate and finally meets the experimentconditions was6patients,At the same time a negative contrast of15patientswith leukemia,30patients with meningeal carcinomatosis.after lumbarpuncture to all subjectscerebrospinal fluid about6ml was quickly inspected.Centrifuge cerebrospinal fluid Using of the Shandon Cytospin4, and Collect4pieces slides of cerebrospinal fluid cell monolayer Respectively for MGG(May-Gruwald-Giemsa staining) and CK, CK7, PLUNCimmunocytochemistry staining;,observed the results in ordinary opticalmicroscope. In addition returned about1.5ml cerebrospinal fluid to detect thelevels of CK、PLUNC in cerebrospinal fluid using ELISA method respectively,and to test level change before and after treatment,then analysis the results.Results:1. CK positive rate was84.48%in58patients with MC, CK7positiverate was56.90%, PLUNC positive rate was44.83%, the combined testpositive rate was91.38%.45cases in the control group with more than1caseof leukemia CK staining positive control group were negative, CK, CK7,PLUNC three kinds of the specificity of the antibodies were higher. In lungcancer group22cases was CK positive, positive rate was88%,16cases ofCK7positive, positive rate was64.00%,17cases of PLUNC positive, positiverate is68%;10cases of gastric cardia cancer8cases of CK is positive, thepositive rate was80%,4cases of CK7positive, positive rate was40%,1caseof PLUNC positive, positive rate10%;7cases of reproductive system andbreast carcinoma6cases of CK is positive, positive rate is85.71%,4cases ofCK7positive, positive rate was57.14%,2cases of PLUNC positive, positiverate is28.57%;13cases in16cases of unknow the primary focal CK ispositive, positive rate was81.25%,9cases of CK7positive, positive rate is56.26%,6cases of PLUNC positive, positive rate was37.5%. After statisticscompared to CK, CK7expressed in four primary tumors, there were nosignificant difference,but PLUNC expression was difference (P=0.01), one of PLUNC expression in lung cancer respectively, and the remaining threegroups have significant difference, while the rest there was no significantdifference between three groups. PLUNC expression in lung cancerrespectively, and the remaining three groups have significant difference, whilethe rest there was no significant difference between three groups.2. The determination of CK and PLUNC in cerebrospinal fluid beforeintrathecal injection of58cases of MC group CK in cerebrospinal fluid in theaverage level of0.984±0.323ng/ml,30cases of control group CK average of0.148±0.072ng/ml, which shows significant difference. ng/ml. CK averagelevel in Lung cancer group was0.928±0.313ng/ml, gastric cardia cancergroup0.910±0.164ng/ml, reproductive system and breast carcinoma group1.172±0.217ng/ml, unknow the primary focal group1.056±0.437ng/ml, fourgroups was no significant difference.PLUNC average level in CSF of58casesof before intrathecal injection was2.058±0.629ng/ml, the control group1.149±0.321ng/ml, both have significant difference. PLUNC average level inLung cancer group was2.503±0.482ng/ml, gastric cardia cancer group1.614±0.226ng/ml, reproductive system and breast carcinoma group1.517±0.518ng/ml, unknow the primary focal group1.827±0.617ng/ml, fourgroups have significant difference. Four groups have significant difference.Lung cancer group compared with the other three groups have significantdifference. Gastric cardia cancer, mammary gland reproductive systemcancerand unknow the primary focal MC groups was no significant difference.6cases accepted intrathecal chemotherapy in patients with MCimmunocytochemistry staining6cases positive for CK,5cases of PLUNCpositive source for lung cancer,1case of primary focal unknown PLUNCexpress negative.6patients with MC were3cases of clinical neural function improved,better CSF cytology, extended survival significantly, at the same time, CSFCK, PLUNC level with treatment gradually decreases;1case of clinical neuralfunction, cerebrospinal fluid cytology were not improved, and there is nodownward trend in CK, PLUNC levels in the cerebrospinal fluid;1case of clinical neural function, cerebrospinal fluid cytology were not improved, andcerebrospinal fluid in2cases after treatment condition continues to progress,and reduced levels in CSF CK in while at the same time, but also caused a rise.PLUNC in1case (that is the lung cancer patients) CSF levels increased.Conclusion:1. CK, CK7and PLUNC immunocytochemistry detection can be used inthe diagnosis of MC,and the three sensitivity were84.48%,56.90%,44.83%,thethree specificity were97.5%,100%,100%respectively..2. PLUNC positive in CSF using immunocytochemistry or CSF PLUNClevels elevated using ELISA method suggested the primary tumor of MC maybe lung cancer, in which the sensitivity of immunocytochemistry dyeing was68%, the specificity was72.73%.3. Monitoring dynamic changes of CK, PLUNC in the CSF incombination of the symptoms,number of tumor cells were of greatsignificance for monitoring the efficacy of treatment4. The condition of better effect for MC treatment were the number oftumor cells in CSF of the patients scattered,glucose level was above2.5g/L,and the transcranial pressure was under200mmH2O in the first lumbarpuncture.