1例非小细胞肺癌软脑膜转移伴昏迷患者临床病理分析  

Clinicopathological analysis of leptomeningeal metastasis with coma in patients with non-small cell lung cancer: A case report

作　　者：蔡婧[1,2] 魏建平 刘安文[1,2] CAI Jing;WEI Jianping;LIU Anwen(Department of Oncology,Second Affiliated Hospital of Nanchang University,Nanchang 330006;Jiangxi Provincial Key Laboratory of Tumor Clinical Transformation,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院肿瘤科,南昌330006 [2]江西省肿瘤临床转化重点实验室,南昌330006

出　　处：《临床与病理杂志》2019年第11期2579-2586,共8页Journal of Clinical and Pathological Research

基　　金：2018CSCO-齐鲁研究基金(Y-Q201802-009)~~

摘　　要：南昌大学第二附属医院肿瘤科收治了1例非小细胞肺癌(non-smallcelllungcancer,NSCLC)软脑膜转移(leptomeningealmetastasis,LM)伴昏迷的患者,女,55岁,因感冒后出现咳嗽就诊,胸部CT示左肺占位。CT引导下经皮穿刺肺活检病理示肺腺癌,免疫组织化学:CK(+),NapsinA(+),TTF-1(+),ALK-D5F3(-),Ki-67约15%(+)。EAR基因检测:EGFR19号位点缺失突变,ALK(-),ROS1(-)。完善相关检查提示肝脏及多发骨转移,给予易瑞沙靶向治疗。1年后患者出现头晕头痛伴嗜睡及意识障碍,全脑全脊髓磁共振提示脑实质及LM。脑脊液细胞学检查见腺癌细胞,脑脊液基因检测阴性。给予奥希替尼联合贝伐珠单抗联合全脑及颈椎椎管放射治疗后患者症状明显缓解。患者体力活动状态(performance status,PS)评分1分,脑膜转移治疗无进展生存期(progression-free survival,PFS)目前达到了15个月,仍在继续随访当中。肺癌LM预后差,如何早期诊断并优化其个体化治疗策略值得探索。A case of non-small cell lung cancer with soft meninges metastasis and coma was admitted to Oncology Department of Second Affiliated Hospital of Nanchang University. The patient, a 55-year-old woman, had a cough after a cold. Chest CT showed left lung mass. CT-guided percutaneous lung biopsy showed lung adenocarcinoma, immunohistochemical showed CK(+), NapsinA(+), TTF-1(+), ALK-D5 F3(-), Ki-67 was about 15%(+). EAR gene detection: EGFR 19 deletion mutation, ALK(-), ROS1(-). Further examination showed liver and bone metastases and Iressa targeted therapy was used. One year later, dizziness and headache with somnolence and disturbance of consciousness appeared. Whole brain spinal cord MRI showed brain parenchyma and leptomeningeal metastasis. Cerebrospinal fluid cytology showed adenocarcinoma cells, cerebrospinal fluid gene detection was negative. The symptoms of the patients were significantly relieved after Osimertinib combined with Bevacizumab combined with whole brain and cervical spinal canal radiotherapy. The performance status(PS) score of the patient was 1, PFS of leptomeningeal metastasis treatment has reached 15 months, and is still being followed up. The prognosis of leptomeningeal metastasis of lung cancer is poor, so how to diagnose early and optimize its individualized treatment strategy is worth exploring.

关 键 词：非小细胞肺癌 软脑膜转移 脑脊液细胞学 靶向治疗 放射治疗 

分 类 号：R73[医药卫生—肿瘤]