meningeal carcinomatosis
Introduction
Introduction to meningeal cancer Meningeal carcinomatosis (MC) refers to the diffuse or multifocal pia mater dissemination or infiltration of malignant tumors. The clinical manifestations are symptoms of brain, cranial nerves and spinal cord injury, which is a special distribution of central nervous system metastases. Type is one of the important causes of death from malignant tumors. Due to the extensive development of cerebrospinal fluid cytology, prenatal diagnosis has been basically achieved. In 1870, Eberth found that cancer cells selectively invaded the pia mater from autopsy cases of lung cancer. The early clinical manifestations were similar to meningitis, but there was no inflammation in pathological anatomy, but cancer cells infiltrated, called cancerous meningitis. basic knowledge The proportion of the disease: the incidence rate is about 0.001% -0.003% Susceptible people: good for middle-aged Mode of infection: non-infectious Complications: brain tumor
Cause
Causes of meningeal cancer
Tumor (95%)
Meningeal cancer is a diffuse or multifocal pial dissemination or infiltration of malignant tumors. It is a special type of distribution of central nervous system metastases. This disease often occurs several months after the diagnosis of primary tumors, and several years, there are also 10 The rest of the year.
Pathogenesis
The way in which cancerous tumors are diffusely transferred to the subarachnoid space of the brain and ridges is reported in the literature:
1 The blood source is transferred to the choroidal blood vessels and reaches the subarachnoid space.
2 blood source transferred to the soft meningeal blood vessels and reached the subarachnoid space.
3 spread along the lymphatic vessels and sheaths around the nerves.
4 Transfer to Batson's vein and reach the submental space.
5 centripetal expansion along the perivascular lymphatic vessels.
The pathological features are: swelling of the brain, diffuse thickening of the pia mater, opacity, yellow exudate can be seen in the subarachnoid space, with the lateral cerebral palsy, the cerebral cistern, the cerebral pons, the dorsal side of the spinal cord and spinal nerve roots, and At the end of the horse, it can have a granulomatous appearance at the bottom of the brain. A nodular tumor is usually formed in the cerebellum and the pony tail of the pons to make the nerve fibers adhere to each other.
Microscopically, the pia mater is infiltrated by a large number of tumor cells and stretches along the meninges to the brain parenchyma. The tumor cells are mostly monolayer or glandular, and tend to grow along the cortical surface, often around the brain and spinal nerves. It surrounds a large number of tumor cells, but rarely invades the brain parenchyma along the peripheral nerves. It can also be seen that different degrees of fibroblast proliferation and vascular response are caused by tumor cell stimulation, and lymphocytes and plasma are scattered around the blood vessels and around the tumor. Cell infiltration, rarely seen acute inflammatory response, domestic reports (Zhang Shuqin et al, 1995), visible meningeal thickening under the microscope, there are ductal cells arranged in the meninges or clustered tumor cells, the size and shape of cancer cells are not Regular, and can see giant cells of the tumor, some tumor cells invade the brain parenchyma or around the blood vessels along the VR cavity, with the extrahepatic lobes and infiltration of cancer cells at the bottom of the brain, and the metastatic cells of the cerebellum, brainstem, etc. .
Prevention
Meningeal cancer prevention
Early diagnosis and treatment of primary tumors is the main preventive measure. Proper treatment can prolong survival, reduce or stabilize nervous system symptoms and signs. Once the disease is found to be treated in time, early detection, early diagnosis, and early treatment are the key to prevention.
Complication
Meningeal cancer complications Complications
More combined with the clinical manifestations of the primary tumor.
Symptom
Symptoms of meningeal cancer Common symptoms Meningeal irritation signs nausea and vomiting limbs weakness spinal nerve root damage damaged around the water conduit
1. It occurs in middle-aged and old people, the gender difference is not obvious, and it is mostly subacute onset, and the clinical progress is fast.
2. The main manifestations are brain, cranial nerve, spinal nerve root damage three groups of symptoms, 50% of patients with first symptoms of brain lesions, such as headache, vomiting, fundus edema, meningeal irritation, mental symptoms, seizures, etc.; 12 pairs The cranial nerves can be damaged, but the most common cranial nerve damage is caused by II to VIII, such as vision loss, ophthalmoplegia, hearing and vestibular dysfunction; spinal nerve symptoms are common with lumbosacral pain to both lower extremities, limbs Inability to accompany paresthesia, paralysis, sputum reflexes disappeared or disappeared, incontinence, etc., and some patients showed Fisher syndrome.
Examine
Examination of meningeal cancer
1. CSF cytology examination CSF pressure increased, the degree is different, the conventional biochemical minority is normal, most abnormal, the number of cells is more than 100 × 106 / L, the protein content is light, moderately elevated, chloride and glucose are reduced, Cerebrospinal fluid cytology examination increased the proportion of monocytes in 60%, the proportion of lymphocytes increased and the proportion of neutrophils increased by 20%, respectively, can be found in malignant tumor cells, most of the tumor cells under light microscopy It is scattered in distribution, a small part is arranged in clusters, and its size and shape are different. It is as small as lymphocytes, and the larger one is 2 to 5 times of lymphocytes. The nucleus is round or oval, multi-biased, active in nuclear division, and some appear in dinuclear Or trinuclear, large and obvious nucleoli, mostly 2, nuclear chromatin is coarse, nucleoplasm ratio is greater than normal, cytoplasmic basophilic, adenocarcinoma cytoplasm contains a large number of mucus vacuoles or the formation of sign-like cells.
2. EEG exhibits a wide diffuse slow wave change.
3. Brain CT and MRI scan more normal or mild traffic hydrocephalus, enhance visible sulci, and strengthen the shadow in the cerebral cistern. Foreign scholars (Watanabe, 1993) proposed MRI enhancement of MC into 4 types: complete type Pia mater cancer; dural cancer; spinal cord dural; simple hydrocephalus, and considered hydrocephalus is an important indirect evidence of MC, sulcal strengthening, nodular changes are characteristic changes of this disease.
Diagnosis
Diagnosis and diagnosis of meningeal cancer
All middle-aged and above, history of malignant tumors, brain symptoms, cranial nerves and/or spinal nerve damage symptoms, and brain CT MRI can not see intracranial space-occupying lesions, should first consider the disease, cerebrospinal fluid cytology The early diagnosis of MC, especially for those whose primary lesions are unknown, may be the only effective diagnostic method. Cerebrospinal fluid cytology found that cancer cells are a reliable basis for diagnosis before birth. The number of cancer cells is related to the disease period.
However, cytological examination is not the first time to find tumor cells, so it is highly suspected that MC should repeatedly perform cerebrospinal fluid cytology to improve the positive rate.
When the primary tumor is unknown and the brain symptoms are the first symptom, it is clinically misdiagnosed as tuberculous meningitis, intracranial space-occupying lesions, and cysticercosis (cysticercosis).
