title: Cerebrospinal fluid abnormalities in meningeosis neoplastica: a retrospective 12-year analysis.
abstract: BACKGROUND
  Meningeosis neoplastica is a diffuse metastatic spread of tumor cells in the subarachnoid space. Although first recognized in 1870, systematic investigations regarding cerebrospinal fluid (CSF) constituents in this condition are scarce.
  
  
  METHODS
  Routine CSF samples analyzed from 2001 to 2012 at the Laboratory of Clinical Neurochemistry, University of Göttingen, were re-evaluated. Patients, whose CSF contained malignant cells were included in this study.
  
  
  RESULTS
  Patients (n = 132, age 59.1 ± 29.1, 58% women) were identified, whose CSF contained malignant cells. The most frequent primary tumor was breast cancer (32.6%), followed by lung cancer (25.0%) and hematologic malignancies (21.2%). The most frequent clinical symptoms were affections of cranial nerves (41.7%), psychiatric abmormalities (32.6%) and radicular lesions of the lower extremities (20.5%). CSF cell counts ranged from 0 to 4692 cells/μl (median 4 cells/μl) and were elevated in 50%. The CSF-to-serum albumin ratio was abnormal in 69.4%. It ranged from 1.8 to 330 x 10-3(median 17.5 x 10-3). Total CSF protein ranged from 166 to 15,840 mg/l (median 1012 mg/l). CSF lactate was elevated (>2.4 mmol/l) in 65.2% [3.6 mmol/l (1.3/15.6 mmol/l); median (minimum/maximum)]. In 50% of all patients CSF lactate was ≥3.5 mmol/l. The CSF cell counts correlated significantly with the CSF lactate levels and the CSF protein contents. In 56 of 118 CSF samples (47.5%) ferritin was elevated, and in 25 of 65 carcinoma patients (38.5%) an intrathecal production of carcinoembryonic antigen (CEA) was detected. Granulocytes were found in 52.7% of the CSF samples. The percentages of granulocytes and lymphocytes were higher in samples with an elevated cell count.
  
  
  CONCLUSIONS
  In approximately 50% of CSF samples with meningeosis neoplastica the CSF cell count is not elevated. Diagnosis may be missed when only CSF samples with elevated cell counts are subjected to cytological analysis. CSF lactate and protein and the CSF-to-serum albumin ratio are frequently increased in meningeosis neoplastica. The differential diagnosis between meningeosis neoplastica and central nervous infections, in particular tuberculous or fungal meningitis, can be difficult.
authors.affiliation: Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany. mdjukic@gwdg.de.|Institute of Neuropathology, University Medical Center Göttingen (UMG), Robert-Koch-Strasse 40, 37075, Göttingen, Germany. mdjukic@gwdg.de.
authors.forename: Marija
authors.initials: M
authors.lastname: Djukic
authors.affiliation: Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany.|Institute of Neuropathology, University Medical Center Göttingen (UMG), Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Trimmel
authors.affiliation: Department of Neurology, University Medical Center Göttingen (UMG), Göttingen, Germany.
authors.forename: Ingelore
authors.initials: I
authors.lastname: Nagel
authors.affiliation: Department of Neurology, University Medical Center Göttingen (UMG), Göttingen, Germany.|Department of Neurology, University Medical Centre Mainz, Mainz, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Spreer
authors.affiliation: Department of Neurology, University Medical Center Göttingen (UMG), Göttingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Lange
authors.affiliation: Institute of Neuropathology, University Medical Center Göttingen (UMG), Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Stadelmann
authors.affiliation: Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany.|Institute of Neuropathology, University Medical Center Göttingen (UMG), Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Nau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000134:cerebrospinal fluid / Q000378:metabolism; D015415:Biomarkers / Q000134:cerebrospinal fluid; D002272:Carcinoembryonic Antigen / Q000134:cerebrospinal fluid; D002452:Cell Count; D003937:Diagnosis, Differential; D005260:Female; D005293:Ferritins / Q000134:cerebrospinal fluid; D006098:Granulocytes; D006801:Humans; D019344:Lactic Acid / Q000134:cerebrospinal fluid; D008214:Lymphocytes; D008297:Male; D008577:Meningeal Neoplasms / Q000134:cerebrospinal fluid* / Q000556:secondary*; D008875:Middle Aged; D012189:Retrospective Studies; D013346:Subarachnoid Space; D055815:Young Adult
chemical_list: D000418:Albumins; D015415:Biomarkers; D002272:Carcinoembryonic Antigen; D019344:Lactic Acid; D005293:Ferritins
keywords: CSF/serum albumin ratio; Carcinoembryonic antigen (CEA); Lactate; Meningeosis carcinomatosa; Meningeosis lymphomatosa; Meningeosis neoplastica