RESUMO
Isolated spinal leptomeningeal metastases (LMM) without brain metastases are infrequent, accounting for about 1% of all solid tumors. In LMM, cerebrospinal fluid (CSF) analyses are mostly abnormal. Demonstrations of intrathecal tumor markers are highly suggestive, but only a positive cytology is diagnostic. The initial CSF cytology can give a false negative result in up to 40-50% of patients with pathologically proven LMM on autopsy. We report a case of intrahepatic cholangiocarcinoma with spinal LMM confirmed using cytokeratin7 and pancytokeratin (AE1/AE3) immunocytochemical studies on paucicellular cerebrospinal fluid cytospin preparation. Given the paucicellularity of the smears and difficult morphologic categorization, immunocytochemistry is vital for confirmatory diagnosis and can help reduce false negative results. To the best of our knowledge this is the first case report of cytologically confirmed LMM from an intrahepatic cholangiocarcinoma while the patient was undergoing treatment.
Assuntos
Colangiocarcinoma/patologia , Colangiocarcinoma/secundário , Imuno-Histoquímica/métodos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/secundário , Idoso , Neoplasias dos Ductos Biliares , Ductos Biliares Intra-Hepáticos , Biomarcadores Tumorais/análise , Biópsia com Agulha de Grande Calibre , Neoplasias Ósseas/secundário , Colangiocarcinoma/líquido cefalorraquidiano , Colangiocarcinoma/química , Feminino , Humanos , Queratina-19/análise , Queratina-7/análise , Neoplasias Hepáticas/líquido cefalorraquidiano , Neoplasias Hepáticas/química , Neoplasias Pulmonares/secundário , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/líquido cefalorraquidiano , Neoplasias Meníngeas/química , Invasividade Neoplásica , CostelasAssuntos
Colangiocarcinoma/secundário , Diplopia/etiologia , Neoplasias Hepáticas/patologia , Neoplasias Meníngeas/secundário , Meningite Asséptica/etiologia , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/fisiopatologia , Idoso de 80 Anos ou mais , Colangiocarcinoma/líquido cefalorraquidiano , Delírio/etiologia , Diagnóstico Diferencial , Diplopia/fisiopatologia , Progressão da Doença , Evolução Fatal , Humanos , Masculino , Neoplasias Meníngeas/líquido cefalorraquidiano , Meninges/patologia , Meningite Asséptica/líquido cefalorraquidiano , Proteínas do Tecido Nervoso/análise , Proteínas do Tecido Nervoso/líquido cefalorraquidiano , Espaço Subaracnóideo/patologia , Espaço Subaracnóideo/fisiopatologia , Tuberculose Meníngea/diagnósticoRESUMO
Differentiating chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis can be difficult, particularly when the differentiation is based solely on routine cytologic examination. The diagnosis of cerebrospinal fluid tumor dissemination in at-risk patients requires cytologic examination of cerebrospinal fluid and radiography of the leptomeninges. Routine cytologic examination alone has proven less than desirable, in most instances providing confirmation in as little as 50% of cases in the first lumbar puncture. This percentage increases to 85% to 90% after multiple lumbar punctures. We retrospectively reviewed 2 cases of leptomeningeal dissemination (one gliomatosis, the other carcinomatosis) with initial false-negative test results. However, after further examination of the cerebrospinal fluid by selected battery of immunocytochemical stains, both cases were identified as positive for malignancy (ie, false negatives). Immunocytochemistry can be useful in distinguishing chronic aseptic meningitis from leptomeningeal carcinomatosis or gliomatosis in patients at risk or when abnormal cells are seen on routine cerebrospinal fluid cytologic examination.
