To Investigate The Value Of Immunocytochemical Stain In The Diagnosis Of Meningeal Carcinomatosis

Objective: Meningeal carcinomatosis (MC) is a devastating complicationof the malignancy from all over the body focal or diffuse infiltration of theleptomeninges/spinal meninges/subarachnoid space via blood/lymphaticvessel, which is one of special rare types of CNS tumor. The clinicalpresentation of MC varies and complexes, depending on the site of meningealinfiltration. Prognosis is poor if the diagnosis is delayed and there is noaggressive treatment after the diagnosis. The median of survival time is about4-6weeks. The imaging has no special performance. Many patients havenervous system symptom when.the tumor cells avert to the arachnoid and piamater of the brain and spinal, without finding the primary tumor site, whichis very difficult to diagnosis.At present, the definitive diagnosis still depends on the presence ofmalignant cells in the cerebrospinal fluid (CSF), The common CSF cytologicmethod is May-Grunwald-Giemsa stain. But when the tumor cells were toopleomorphism to distinguish, it is hard to determine the primary site justdepending on the morphological changes.Immunohistochemical is a rapid,economical and special method inlaboratory, and it has a special role in tumor cells diagnosis and organizationtypes determination, especially in metastatic adenocarcinoma.Immunocytochemical staining has a clear background of cells in SCF, it isvery easy to identify tumor cells, further more, the specimens are easy to besaved. Therefore, it becomes one of the most common auxiliary diagnosticmethods of cerebrospinal fluid cytology, We have observed the expression ofcarcino-embryonic antigen (CEA), epithelial embrane antigen (EMA),cytokeratin7(CK7), cytokeratin20(CK20) in CSF of MCs, in order to (1)improve the sensitivity and specificity of the MC diagnosis;(2) assist to find the primary tumor site of the patients, who develop MC as the first clinicalsymptoms.Methods: The52patients of MC were definitely diagnosed in theneurological department of the second hospital of HeBei medical universityfrom the March,2009to the October,2011. There were25patients whoseprimary tumor sites were lungs,7patients whose primary tumor sites werestomachs,2patients whose primary tumor site were breasts,1patient whoseprimary site was melanoma. There were also17patients who had not foundthe primary tumor site was melanoma. There were also50patients as controlgroup. All patients received lumbar puncture, and we collected6ml ofCSF.The Shandon Cytospin4centrifugal sedimentation instrument was used tocentrifugate CSF.6CSF cell smears of each patient were used to be stain withMay-Grunwald-Giemsa (MGG), and with carcino-embryonic antigen (CEA),epithelial membrane antigen(EMA),cytokeratin7(CK7), cytokeratin20(CK20)respectively. The immunocytochemical staining used SP method and thesmears were observed in ordinary optical microscope. Brown particledeposition inside the cytoplasm was positive in the immunocytochemicalstaining, colorless was negative result. The data was analysised with SPSS13.0software.Results: Malignant cells were found in all of52cases for repeated CSFtesting. The positive rate of the first May-Grunwald-Giemsa stain of MCs was69.2%(36/52). The positive rates with CEA, EMA, CK7and CK20immunocytochemical stain were respectively78.85%(41/52),82.69%(43/52),88.46%(46/52) and9.62%(5/52). The four antigens combined together fortesting could improve the sensitivity of diagnosis of MC to96.15%(50/52),and the specificity of diagnosis of MC was100%.In the25patients of MC from lung cancer, The positive rates ofimmunocytochemical stain of CEA,EMA,CK7and CK20were respectively76%(41/52),84%(43/52),92%(46/52)and8%(5/52),The highest positive rateof immunocytochemical stain of the four antibodies was CK7In the7patients of MC from gastric cancer, The positive rates of immunocytochemical stain of CEA, EMA, CK7and CK20were respectively71.43%(5/7),57.14%(4/7),71.43%(5/7) and28.75%(2/7), The highestpositive ratios of immunocytochemical stain of the four antibodies were CK7and CEA, but the4antibodies were not statistically significant, P>0.05. Therewere2patients of MC from breast cancer. The immunocytochemical stain ofCEA, EMA and CK7were all positive, while CK20was negative, but thecases were too few to analyze in statistics.The positive ratio of immunocytochemical stain of CK7+/CK20was84%in25patients of MC from lung cancer, and CK7+/CK20+was8%ï¼›CK7/CK20was8%;There was not CK7/CK20+; The positive rate ofimmunocytochemical stain of CK7+/CK20was57.14%in7patients ofMC from gastric cancer, and CK7+/CK20+,CK7/CK20-and CK7/CK20+were the same positive ratio, which was14.29%. CK7+/CK20wasstatistically significant in distinguish MC patients of lung cancer from gastriccancer, P<0.05. The others were not statistically significant, P>0.05.Conclusions:1CK7, CK20were detectes in the cerebrospinal fluid specimens of patientswith meningeal carcinomatosis for the first time by immunocytochemicalstaining method, which is effective.2The positive ratio of CK7was the highest in the diagnosis of MC, Thecombination of CK7, CK20, CEA and EMA4used in the diagnosis of MCcan improve the sensitivity and specificity.3CEA, EMA can not assist to search to the primary site of MC.4CK7+/CK20was statistically significant in distinguish MC patients oflung cancer from gastric cancer.