原发性中枢神经系统淋巴瘤46例临床、影像及病理分析  

Clinical,radiological and pathological features of forty-six primary central nervous system lymphoma

作　　者：夏德雨[1] 郑奎宏[2] 董秦雯[1] 姚生[1] 赵虎林[3] 刘建国[1] 戚晓昆[1] 

机构地区：[1]海军总医院神经内科,北京100048 [2]海军总医院影像科,北京100048 [3]海军总医院神经外科,北京100048

出　　处：《北京医学》2015年第5期408-411,共4页Beijing Medical Journal

基　　金：首都医学发展科研基金(2009-2054)

摘　　要：目的 总结原发性中枢神经系统淋巴瘤（primary central nerous system lymphoma,PCNSL）的临床、影像及病理特点。方法 回顾分析海军总医院2007-2013年经病理证实的PCNSL患者的临床资料。结果 本组46例,男26例,女20例;年龄13~80岁,平均（55±20）岁,以中老年为主（35例）,大部分亚急性或慢性起病,主要表现为肢体运动障碍、颅内压增高及认知障碍等。影像学主要表现为头颅CT稍高密度影（30例）,头颅增强MRI病灶强化（44例）;多发病灶37例,累及幕上35例,累及中线结构33例。本组患者均经活检证实,其中立体定向活检44例,开颅活检2例。病理诊断：弥漫大B细胞型淋巴瘤45例,T细胞淋巴瘤1例;其中增殖指数Ki-67〉90%39例。部分病例术前诊断困难,其中初诊时误诊为脑梗死5例、脱髓鞘病5例、病毒性脑炎2例。术前使用激素可影响活检结果。结论PCNSL临床表现复杂,主要表现为肢体运动障碍、颅内压增高及认知障碍等;影像学主要表现为CT稍高密度影,增强MRI病灶强化;病理类型以弥漫大B细胞型淋巴瘤多见;部分病例术前诊断较为困难;术前使用激素可影响病理结果。Objective To Summarize the clinical, radiological and pathological features of primary central nervous system lymphoma. Metheds The clinical data of patients with pathologically confirmed PCNSL in 2007-2013 were retrospectively reviewed, of which 26 males and 20 females, aging from 13 to 80 years old, mean age （55.1±20） years. Results Most of the patients were middle-aged （35 cases）, and the majority were subacute or chronic onset. Limb movement disorder, increased intracranial pressure and cognitive disorders were common. Thirty cases had hyperdense CT imaging. Forty-four cases had enhancement in enhanced MRI. Thirty-seven cases had multiple lesions and 35 cases in the supratentorial area. The midline structures were involved in 33 cases. Forty-four cases had stereotactic biopsy and two cases had cranial lesion biopsy. Forty-five cases were pathologically diagnosed as diffuse large B-cell lymphoma and one diagnosed as T-cell lymphoma. The proliferation index of 39 cases was greater than 90%. The preoperative diagnosis was difficult. Five cases were misdiagnosed as cerebral infarction. Five cases were misdiagnosed as demyelinating dis- ease. Two cases were misdiagnosed as viral encephalitis. The use of glucocorticoid could interfere with the biopsy re- suits. Conclusion The clinical manifestations of PCNSL are complicate, and the main clinical manifestations are the dis- order of limb movement, increased intracranial pressure and cognitive disorders. Most PCNSL shows hyperdense on CT imaging and enhancement on MRI. Pathologically, most of the cases are diffuse large B-cell type. Preoperative diagnosis is difficult. The use of glucocorticoid may interfere with the final pathological diagnosis.

关 键 词：原发性中枢神经系统淋巴瘤 大脑淋巴瘤病 弥漫大B细胞型淋巴瘤 脑组织活检 

分 类 号：R739.4[医药卫生—肿瘤]