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Objective The cerebrospinal fluid (CSF) cytological and imaging features in 4 patients with meningeal carcinomatosis (MC) were investigated to assist with the diagnosis and improve the treatment of the disease. Methods A retrospective analysis was utilized to investigate the clinical manifestations, imaging, and liquid-based CSF cytology of 4 patients with MC by using CSF cytology, all of whom were treated at the Department of Neurology at Wuhan No.1 Hospital from February 2016 to January 2019. Results Four patients (2 males and 2 females) with an average age of (60.00 ± 15.85) years old had a symptom of headache, 2 of whom had a symptom of slow response. Among 4 patients, all had a history of tumor disease; 2 had a history of lung cancer; one had a history of gastric cancer; one had a history of breast cancer. Four patients underwent lumbar puncture. Two patients had increased white blood cell count, and the other 2 demonstrated decreased glucose levels. Three patients had elevated protein levels. There were 3 cases with increased intracranial pressure (ICP) and 4 cases with atypical cells, as indicated by liquid-based CSF cytology. However, no apparent meningeal enhancement was found in 4 patients. One of the patients had a negative PET-CT. All patients had been receiving or received symptomatic treatment during hospitalization. Post hospital discharge, one patient had been in treatment, and the other 3 patients died within one month to one year after diagnosis. Conclusions The imaging findings of patients with MC were atypical. The clinical history of patients with MC can help with diagnosis. The CSF cytology on these patients has considerable significance to diagnosis. [ABSTRACT FROM AUTHOR]

Background: Morvan syndrome is a rare disorder characterized by the combination of peripheral nerve hyperexcitability, encephalopathy and dysautonomia with marked insomnia. It was reported to have association to antibodies to voltage-gated potassium channels including contactin associated protein-like 2 antibodies (CASPR2-Ab) and leucine-rich glioma inactivated protein 1 antibodies (LGI1-Ab). LGI1-Ab was reported to associate with seizures, amnesia, confusion, hyponatraemia and a good prognosis, while CASPR2-Ab with peripheral presentations, probable risk for tumor and a poor prognosis. The vast majority of Morvan syndrome patients were male, with normal magnetic resonance imaging of the brain.Case Presentation: We report a female case presenting with a combination of bilateral leg pain, widespread myokymia, memory disturbance, seizure, hyperhidrosis and insomnia. She had antibodies targeting CASPR2 and LGI1, tested by the indirect immunofluorescence test, which demonstrated the diagnosis of typical Morvan syndrome as well as classical limbic encephalitis. Cranial MRI revealed bilateral hyper-intensity of the medial temporal lobe, insular lobe and basal ganglia on T2/FLAIR and DWI sequence. As the treatment carried on, her serum LGI1-Ab disappeared and her memory loss, seizure and confusion quickly relieved. But her peripheral presentations did not relieve until serum CASPR2-Ab turned negative. Intravenous immunoglobulin treatment showed limited efficacy while she achieved almost complete remission with corticosteroids therapy.Conclusions: This case provides a rare female resource of Morvan syndrome, which is the first patient with both CASPR2-Ab and LGI1-Ab positive Morvan syndrome in China and one of the few female patients with Morvan syndrome reported so far. Through the detailed analysis of her clinical course, the diverse and overlapping clinical phenotype of CASPR2-Ab and LGI1-Ab in patients with Morvan syndrome was obvious and interesting. [ABSTRACT FROM AUTHOR]

We report a rare case of multicentric reticulohistiocytosis (MRH) associated with liver carcinoma. A 36-year-old man who had been diagnosed as having liver carcinoma for 2 years presented with a 2-month history of multiple papulonodules on the face, ears, neck, and upper chest, accompanied by progressive polyarthralgia of the hands, wrists, elbows and knee joints without fever or chills. Skin histology revealed well defined dermal infiltrate consisting of multinucleated giant cells and macrophages having abundant eosinophilic finely granular cytoplasm with ground glass appearance. Further immunohistochemical studies characterized the lesions as positive for CD68, CD45 and Vimentin. A diagnosis of MRH that was associated with liver cancer was made. Treatment with prednisolone for 2 months resulted in a significant improvement of the skin and joint symptoms, but was discontinued due to his significant enlargement and extensive metastases of the liver carcinoma.