Analysis Of 48 Patients With Meningeal Carcinomatosis In Qilu Hospital Of Shandong University

Background:Meningeal carcinomatosis (MC) is also called neoplsetic meningitis, is one special distribution type of the central nervous system metastases, and is defined as the malign disease which is called by the metastasis of tumore cell to meninges and spinal. And with the clearance invade surrounding the brain cortex to cause a series of clinical syndrome.In general, there is no substantial lesions in the brain parenchyma. Meningeal carcinomatosis is not easy to find, has special transfer form, the clinical manifestations and imaging studies are lack of specificity, and clinical diagnosis is difficult. Meningeal carcinomatosis is easy to misdiagnosis and missed diagnosis, so that patients can’t get timely treatment that cases the rate of death to increase.Objective:Through the study of the statistical analysis and retrospective analysis of 48 cases of patients with meningeal carcinomatosis. This study can help sum up the clinical characteristic of meningeal carcinomatosis, clinical manifestation, characteristics of cerebrospinal fluid cytology, as well as the characteristics of imaging examination, the understanding of meningeal carcinomatosis has a comprehensive system, early diagnosis. This study can help reduce missed diagnosis and misdiagnosis, have a timely treatment, improve the survival rate and improve prognosis effect.Methods:From January 2007 to March 2016,48 cases of MC that were hospitalized in Qilu hospital of Shandong university were entered into this study. There are 23 cases of men,25 cases of women.and the youngest was 14 years old, the oldest was 74 years old, the age of Most patients I was over 40,the average age was 51.3 years. The shortest time of course of disease was 10 days, the majority was made a definite diagnosis with 1-3 months. This study analyzing included sex, age, course of the disease, clinical manifestation form (main), symptoms (meningeal irritation sign, pathological sign).The results of lumbar puncture included the color of the cerebrospinal fluid, pressure, routine and biochemical examination, oligoclonal band, cytology. Index changes in serum sodium potassium chloride. Imaging studies, including the craniocerebral CT, cerebral MRI, cerebral MRI enhancement scanning and existing primary tumors, etc. The obtained data was statistically analyzed with SPSS20.0.Results:48 cases patients, the incidence ratio of men and women wsa0.92:1, the sex difference was not obvious, and the average age was 51.3 years old, middle aged and elderly patients were prone to disease, Meningeal carcinomatosis mostly acute or subacute onset and clinical progress rapidly. Clinical manifestations include headache 91.7%(44 cases), nausea and vomiting 75%(36 cases), dizziness 27%(13 cases), disturbance of consciousness 20.8%(10 cases), eyesight drops 31.3%(15 cases), epilepsy 14.6%(7 cases), hearing loss 14.6%(7 cases), limb weakness 14.6% (7cases), difficulty swallowing, drinking water choking cough in 2 cases, psychiatric symptoms in 2 cases, papilloedema in 1 case, meningeal irritation sign 75%(36 cases), pathological sign 10.4%(6 cases).48 patients were performed lumbar puncture and carried out examination of lumbar puncture cerebrospinal fluid. Colorless and transparent cerebrospinal fluid 91.7%(44 cases), increased pressure on 72.9%(35 cases) and normal (12 cases) 25% and decrease in 1 case. In the examination of routine CSF,white blood cell count (1-80) by 106, white blood cells increased in 34 cases, accounting for 70.8%,high protein (18 cases), an 37.5%,glucose reduced by 31.3%(15 cases),33.3% lower chloride (16 cases), lactic acid increased by 83.3%(40 cases). In the examination of erebrospinal fluid cytology, there were 34 cases that can be fund the cancer cells 70.8%,18.8% can’t be classificated (9 cases), suspected to be 10.4%(5 cases).In this study,there were 43 cases that were carried out routine imaging examination (craniocerebral CT, MRI, enhanced scan). The rate of abnormal meninges in head MRI scan was 9.3%(4 cases), and abnormal meninges enhancement sign in head MRI enhancement scan was 23.3% (10 cases). Serum tumor markers were detected in 41 patients, and there were no abnormal serum tumor markers in 9 cases.32 cases of abnormal indicators, accounting for 78%(32/41).29 cases had primary tumor,23 cases from lung cancer (including 3 cases with bone metastasis),3 cases of breast cancer, gastric cancer in 2 cases,1 case of nasopharyngeal carcinoma (NPC). Primary tumors were not found in 19 cases.Conclusion:The sex difference of patients with meningeal carcinomatosis is not obvious, meningeal carcinomatosis can be found at any age and occurs in middle-aged and old mostly. Clinical manifestations are complex, with a lack of specificity. Cerebral MRI enhanced scan can show the meninges strengthening, which has a certain guiding value to the diagnosis of meningeal carcinomatosis, but lack of specificity. In CSF cytology, finding the cancer cells can provide the important evidence for the diagnosis for meningeal carcinomatosis which is the gold standard in the diagnosis of meningeal carcinomatosis.