原发性中枢神经系统淋巴瘤临床表现、影像学特征及病理诊断分析  

Clinical Manifestations,Imaging Features and Pathological Diagnosis of Primary Central Nervous System Lymphoma

作　　者：王海莉[1] 张中冕[1] 

机构地区：[1]郑州大学第二附属医院肿瘤科,河南郑州450014

出　　处：《中国实验血液学杂志》2018年第1期171-176,共6页Journal of Experimental Hematology

摘　　要：目的:分析原发性中枢神经系统淋巴瘤临床表现、影像学特征及病理诊断。方法:选取我院肿瘤科2008年2月到2016年2月期间收治的50例原发性中枢神经系统淋巴瘤患者的临床资料进行回顾性分析。对所有患者均进行常规病理及免疫组化染色检测,其中对15例进行MVD与VEGF检测,取另外15名胶质瘤患者作为对照组。结果:50例患者为慢性起病,主要临床症状为肢体麻木、认知障碍、意识障碍等。影像学检查发现,头颅CT图像主要呈稍高密度影,有33例(66%);头颅增强MRI病灶强化,有46例(92%);颅内多发病灶38例(76%),浸润小脑幕上36例(72%),浸润中线结构11例(22%)。病理学诊断表明,有47例(94%)以弥漫大B型淋巴细胞瘤为主,增殖指数Ki-67高于90%的患者41例(82%)。结论:原发性中枢神经系统淋巴瘤以弥漫大B细胞型淋巴瘤为主,其临床表现复杂、缺乏特征,影像学表现具有一定特征性,但少部分容易误诊,需要结合病理活检进行确诊。Objective： To analyze the clinical manifestations,imaging features and pathological diagnosis of patients with primary central nervous system lymphoma. Methods： The clinical data of 50 patients with primary central nervous system lymphoma admitted in our hospital from February 2016 to February 2008 were retrospectively analyzed. All the patients were examined by routine pathology and immunohistochemical staining. Among them 15 cases were examined by MVD and VEGF,and the other 15 glioma patients were taken as control group. Results： In 50 patients,the disease was chronic,and the main clinical symptoms were numbness,cognitive disorder and disorder of consciousnessetc. Brain CT image of 33 cases（ 66%） mainly showed slightly higher density; 46 cases（ 92%） had head enhanced MRI lesions;38 cases（ 76%） showed intracranial multiple lesions,36 cases（ 72%） showed invasion of supratentorial,and 11 cases showed midline invasion（ 22%）. Pathological diagnosis confirmed 47 cases（ 94%） with diffuse large B cell lymphoma,the proliferation index of the Ki-67（ 90%） in 41 case（ 82%） was higher. Conclusion： Primary central nervous system lymphoma is manifested with diffuse large B cell lymphoma as its main type,or with complicated clinical manifestations,lacks of features and certain imaging characteristics, but a fewpatients are easily pathologically misdiagnosed,therefore the biopsy is necessary for diagnosis of these patients.

关 键 词：原发性中枢神经淋巴瘤 临床表现 影像学特征 病理诊断 

分 类 号：R733.1[医药卫生—肿瘤]