侧脑室穿刺引流脑组织病理活检诊断脑膜癌瘤病2例  

Diagnosing Meningeal Carcinoma by Brain Draining Tissue Biopsy after Ventricular Puncture:Two Cases and Literature Review

作　　者：肖卫民[1] 石铸[1] 

机构地区：[1]东莞市人民医院神经内科,广东东莞523000

出　　处：《中山大学学报（医学科学版）》2009年第A04期130-133,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：东莞市科技计划重点资助项目(2008105150027)

摘　　要：【目的】探讨侧脑室穿刺引流组织病理检查对颅内高压疾病的定性诊断意义和取材、阅片过程中的要点。【方法】2例不明原因的颅内高压患者,为缓解症状行侧脑室穿刺引流术,引流脑组织经甲醛固定、石蜡包埋后进行常规HE以及免疫组织化学染色。结合病史以及HE染色结果选用抗体包括LCA、PSA、CK-7、CK-20以及BCA-225。【结果】本组患者最终明确诊断为脑膜癌瘤,分别为肺腺癌和乳腺癌脑膜转移;病理组织学特点为癌细胞散在或成团分布在血肿组织和脑组织碎屑中,伴有炎症细胞反应。【结论】侧脑室穿刺引流是颅内高压的一种对症治疗措施,其引流脑组织病理检查对颅内高压的定性诊断具有十分重要的临床意义,取材过程中应注意尽量收集包括陈旧性的血肿组织在内的各种组织碎屑,结合病史进行针对性的免疫组化研究有助于确定原发病灶。[Objective] To investigate the clinical significance of draining brain tissue biopsy with ventricular puncture for patients with idiopathic intracranial hypertension and the highlights during pathological examination. [Methods] Two patients, with undefined intracranial hypertension, performed ventricular puncture to ameliorate intracranial hypertension. The brain tissues obtained during operation were collected and proceeded with formalin fixation, paraffin embedding and routine HE and immunohistostaining. LCA, PAS, CK-7, CK-20 and BCA-225 antibodies were adopted respectively according to history and HE staining results. [Results] Meningeal carcinoma was defined ultimately. One was pulmonary adenocarcinoma, the other was mammary adenocarcinoma. The pathological examination revealed carcinoma cells distributed among hematoma and brain tissue debris with inflammatory reaction around. [ Conclusion] ventricular puncture was applied before as a kind of symptomatic treatment. However, pathological examination of brain tissue debris during ventricular draining played an important role in determining the etiology of intracranial hypertension. Every tissue debris including obsolete hematoncus scraps should not be discarded. Immunohistostaining in accordance with clinical manifestation helped to determine the primary location of metastatic carcinoma.

关 键 词：侧脑室穿刺引流 颅内高压 脑膜瘤 诊断 

分 类 号：R74[医药卫生—神经病学与精神病学]