The Clinical Features And Laboratory Research Of Meningeal Carcinomatosis

Objective: Meningeal carcinomatosis is a special kind of cancer. The tumor cells avert to the arachnoid and pia mater of the brain and spinal, but it could not be discovered either grossly or microscopically in the parenchyma of central nervous system. It is a kind of non-independent diseases. It was 5% in patients with solid tumor, but the frequency of disease in autopsy series averages 20%. With the improved neuroimaging techniques and longer survival in patient, the frequency of neoplastic meningitis is increasing. Adenocarcinoma is the most frequent histology and lung, gastric,and breast are the most common primaries to metastasize to the leptomeninges .The primary site of MC is hidden,the way of accessing to the CSF is special. The tumor cell often avert to the meninges and result to signs and symptoms referable to increased intracranial pressure, for example, headead ,nausea and vomiting before finding the primary site. Therefore, scope for increasing attentiveness to the warning symptoms and improving care in diagnostic procedures in order to recognize when tumor invasion of the leptomeninges is present. Present the method of cerebrospinal fluid cytology(CSFC) is the primary examination method. The common cytologic method was May-Gruwald- Giemsa stain. But when the tumor cell pleomorphism was untypical and diffcult to distinguish, it was hard in qualitative diagnosis just depending on cell morphological changes. In order to improve the accurate diagnosis rate in MC, our subject collected the clinical data and summary the clinical features. In laboratory research, on the basis of MGG stain we combined carcino-embryonic antigen with epithelial embrane antigen in two methods. We used immunocytochemical stain examination and double immunofluorescence staining that be observed in Laser Scanning Confocal Microscope (LSCM)——From cell morphological to molecular Level. Methods: The 30 patients with MC were definitely diagnosed in hebei medical hospital. We collected data included sex, age, the primary site, neurological signs and symptoms at presentation, CSF levels of pressure, glucose, protein, findings on computed tomography (CT) or magnetic resonance imaging (MRI); All patients CSF were collected in 24 to 48 hours. Shandon Cytospin4 centrifugal sedimentation instrument to collect cerebrospinal fluid cells. The CSF cell smears were used to be stain with May-Gruwald-Giemsa stain, carcino-embryonic antigen and epithelial membrane antigen Immunocytochemical stain ,double immunofluorescence staining respectively. The immunocytochemical staining used SP method and observed in ordinary optical microscope, brown particle deposition inside the cytoplasm was positive in the immunocytochemical staining, colorless was negative result. In the fluorochrome of double immunofluorescence staining, Cy5 (markered of goats resistance rat IgG) was used to tagged anti CEA antibody,anti EMA antibody and DAP(I4',6-diamidino-2-phenylindole) was used to tagged all the cell nucleus DNA, under the laser scanning confocal microscope(LSCM) to observe the result and analyzed in locating, qualitative, quantitative and 3-D image reconstruction. There were 25 cases negative controls with carcino-embryonic antigen Immunocytochemical stain and double immuno- fluorescence staining respectively. We compared sensitivity and specificity of three methods, and concluded their superiority and inferiority.Results: The clinical features lacked specificity. Most of patients inmiddle and elder aged were at acute or subacute onset. The signs and symptoms divided into deficits related to cortical, cranial nerve or spinal involvement.The most common manifestations of MC were headade, nausea andvomit. Most MC do not transfer into parenchymal, so CT and conventional MR scans were of little help. Gadolinium enhanced MR scanning have animportant role in diagnosis of MC. Malignant cells were found in all of 30cases for repeated CSF testing. The positive ratios with MC of the first May-Gruwald-Giemsa stain was 80.00%(24/30). The positive ratios with CEA Immunocytochemical stain and EMA Immunocytochemical stain were 76.67%(23/30) and 83.33% (25/30), Combine two kinds of antigens (CEA and EMA ) can improve the sensitivity of diagnosis. The positive ratios with double immunofluorescence staining is the same as Immunocytochemical staining . The CEA or EMA positive cells with MC were red cytoplasm and membrane around blue nucleus under LSCM. The CEA or EMA negative cells both of patients with MC and negative controls just appeared blue nucleus. Quantitative Analysis of LSCM appeared that the average fluorescence intensity of negative controls about CEA or EMA were (222.45±86.64). The CEA positive cells with MC were (1189.94±340.23) and the EMA positive cells with MC were (1189.94±340.23) respectively. When the MC group of CEA (+) or EMA (+) compared with control group, the average fluorescence intensity both CEA and EMA were significant differences (P<0.01);Conclusions:1 We consider the patients of middle and elder aged with increased Intracranial pressure and meningeal irritation sign unexplained may the patient of MC.2 Gadolinium enhanced MR scanning have an important role in diagnosis of MC.3 May-Gruwald-Giemsa stain of CSFC is the main method in diagnosing MC at present.4 The positive ratios with CEA Immunocytochemical stain and EMA Immunocytochemical stain are 76.67%(23/30) and 83.33% (25/30).5 Combining CEA with EMA can improve the sensitivity of diagnosis.6 LSCM and immunofluorescence staining improve the diagnostic level of MC in locating, qualitative and quantitative.