模仿免疫相关大脑炎的膀癌致癌性脑膜炎:一个病例报告
Filippo Cordaro1, Andrea Barresi1, Francesco Bencivinni2
1Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy.
概括
一种罕见的膀癌并发症,表现为非特异性症状. 这一案例凸显了诊断的挑战,
科学领域:
- 癌症学
- 神经学
背景情况:
- 一名65岁的男性有吸烟史,高血压和脂质失调,出现尿失调和血.
- 图像检查显示了肌肉侵入性膀癌和直肠缩;活检证实了高度泌尿器癌 (pT2) 和直肠腺癌.
研究的目的:
- 报告一个罕见的乳腺癌的病例,
- 讨论这种罕见并发症的诊断挑战和治疗方法,特别是在接受免疫治疗的患者中.
主要方法:
- 用对比度增强的CT和MRI扫描进行瘤分期和神经评估.
- 组织病理学检查活检和脑脊液 (CSF) 细胞学诊断.
- 治疗包括化学疗法 (gemcitabine/cisplatin,然后是carboplatin),放射疗法和免疫疗法 (Avelumab).
主要成果:
- 患者在开始免疫治疗后出现神经症状 (部疼痛,姿势不稳定).
- 神经成像显示小脑胀和瘦骨增强,最初怀疑是瘤或免疫治疗相关的效应.
- 尽管PET-CT对远程转移的初步结果是负面的,但CSF分析证实了泌尿器起源的膜转移.
结论:
- 膜癌是一种罕见但关键的泌尿器癌的表现.
- 由于非特异性症状和免疫治疗副作用的重叠,诊断可能具有挑战性.
- 早期的神经成像和脑脊液细胞学至关重要;管理主要是缓解性.
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