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- 头痛脑脊液检查
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Our fellow showed a case last week. I think it is interesting. Send here as a chinese new year gift for some ones interested.
about 50 y women with headach, CSF cytology exam. paitent has no previous malignant history.
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本帖最后由 于 2010-02-13 10:36:00 编辑
×参考诊断
最后诊断：恶性黑色素瘤，结合临床，可能原发于脑膜。
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Most people think it is at least suspicious for malignancy. Patient had complete body exam and imaging study and did not find the lesion of other organs. Also blood work was normal. Clinicians asked pathologists if there was some way to help to make the final dx. There was no more CSF left. What is your suggestion?
| 以下是引用掌心0164在2010-3-7 10:03:00的发言： 不会看脑积液，从细胞学基础知识看我首先考虑：感染性病变导致的反应性改变，需要排除一下血液系统的疾病，从目前的图片看好像恶性证据不足。 |
掌心0164,
Have seen you in the web for a long time. You must have had a good time for your new year.
需要排除一下血液系统的疾病: Blood tests were fine.
感染性病变导致的反应性改变: Are you sure?
What reactive cells can like the cells above?
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liguoxia71 离线
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本帖最后由 于 2010-03-07 23:04:00 编辑
看到再次送检的CSF涂片，仍然考虑为恶性。
原发、继发？
癌、非癌？
图中可见到个别细胞核明显偏位、胞质中见到不光滑的空泡，核分裂活跃，细胞核大小不一，核仁明显，似乎还能见到少许细胞邻接和排列趋势。
考虑为转移性腺癌，建议：查消化道；尚不全排除原发可能，如果永远也发现不了原发灶的话。
但是，有没有可能是造血系统疾病呢？很多细胞的那张图（含两个分裂像的）猛一看象是白血病。会不会是腔性弥漫大B细胞淋巴瘤？纯属猜测，能用流式细胞仪多做几项标记看看就好了。
- “人生没有彩排，每一天都是现场直播”
