脳脊髄液の免疫染色により診断された髄膜黒色腫症の1例

[A case of meningeal melanomatosis diagnosed by immunostaining of cerebrospinal fluid].

• Yukiko Tamura
• Yoshitaka Umeda
• Maiko Umeda
• Mutsuo Oyake
• Hiroyuki Usuda
• Nobuya Fujita

抄録

49歳女性が高血圧性脳症の疑いで当院に入院した．MRIによる網膜増強とCSFのクラスV細胞診で網膜癌腫症と診断された．原発部位は認められなかったが、3回目のCSF検査では数個のメラニン顆粒が認められた。髄液中の非定型細胞は悪性黒色腫の特異的マーカーであるHMB-45とS-100の免疫反応性を示した。髄膜黒色腫症は日本ではほとんど報告されていない。本症例は、原発部位不明の新生物からの鱗片状髄膜癌腫症の診断に免疫染色が有用であることを示している。

A 49-year-old woman was admitted to our hospital with suspected hypertensive encephalopathy. On the basis of MRI showing leptomeningeal enhancement and Class V cytology of the CSF, she was diagnosed as having leptomeningeal carcinomatosis. Although no primary site was detected, a few melanin granules were observed at the third CSF examination. The atypical cells in the CSF demonstrated immunoreactivity for HMB-45 and S-100, which are specific markers of malignant melanoma. There have been few reports of meningeal melanomatosis in Japan. This case illustrates that immunostaining is diagnostically useful in patients with leptomeningeal carcinomatosis from neoplasms with unknown primary sites.