影像和术中冰冻误诊为脑膜瘤的颅内Rosai-Dorfman病1例报道并文献复习  

Intracranial Rosai-Dorfman disease misdiagnosed as meningioma by imaging and intraoperative freezing:a case report and literature review

作　　者：刘燕[1,2] 向月[2] 陈筱莉 陶佳[1,2] 蹇顺海 LIU Yan;XIANG Yue;CHEN Xiaoli;TAO Jia;JIAN Shunhai(Department of Pathology,North of Sichuan Medical College,Nanchong,Sichuan 637000,China;Department of Pathology,Hospital Affiliated to North of Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院病理教研室,四川南充637000 [2]川北医学院附属医院病理科,四川南充637000

出　　处：《重庆医学》2021年第18期3154-3158,共5页Chongqing medicine

基　　金：四川省教育厅课题(15ZB0203);四川省南充市校科技战略合作项目(18SXHZ0095)。

摘　　要：目的探讨颅内原发性Rosai-Dorfman病(RDD)影像学表现、术中冰冻、术后石蜡病理特点、诊断、鉴别诊断及治疗方法,以提高对该病的认识。方法对1例经病理确诊的RDD患者临床病史、CT、磁共振成像(MRI)、术中冰冻、术后石蜡切片及免疫组织化学标记的病理特点进行回顾性分析,并复习相关文献。结果患者为老年男性,头颅CT显示右侧颞部见团块状密度影,MRI显示右侧颞部结节状异常信号影,T1WI呈稍低信号,T2WI呈低信号,T2FLAIR呈低信号,可见“脑膜尾征”。术中冰冻切片镜下组织细胞特征不明显,见较多炎细胞浸润,诊断为良性病变,考虑为脑膜瘤。术后石蜡切片可见“明暗”相间的组织学特征,暗区由大量淋巴细胞和浆细胞组成、明区可见细胞质淡染的组织细胞,伴有纤维化,部分组织细胞质内可见吞噬淋巴细胞的现象;免疫组织化学染色结果显示组织细胞CD68和S-100蛋白标记阳性。结论颅内原发RDD较少见,术中冰冻易与富于淋巴细胞浆细胞型脑膜瘤、慢性炎症性病变等混淆,术后石蜡及免疫组织化学染色有助于其鉴别。Objective To better understand the diagnosis,differential diagnosis and treatment of the primary intracranial Rosai-Dorfman disease(RDD)by analyze the imaging manifestations,intraoperative freezing,postoperative paraffin pathological characteristics.Methods The clinical features,CT,magnetic resonance imaging(MRI),intraoperative freezing,postoperative paraffin section and immunohistochemical markers in 1 case of primary intracranial RDD were analyzed,along with literature review.Results The patient was an old man,CT showed mass density shadow on the right temporal part.MRI showed a nodular abnormal signal shadow on the right temporal part,T1WI showed slightly low signal,both T2WI and T2flair showed low signal."meningeal tail sign"was seen.The histological features of the intraoperative freezing was not obvious,just much inflammatory cells was observed.It was diagnosed as benign lesions and considered as a meningioma.The postoperative paraffin section was characterized by"light and dark areas alternation"features in HE staining,and accompanied with fibrosis.With a large number of lymphocytes,plasma cells and histiocytes,some phagocytosis of lymphocytes by histiocytes could be seen.Immunohistochemical staining showed that CD68 and S-100 protein markers were positive in histiocytes.Conclusion The primary intracranial RDD is rare.During the intraoperative consulting,it is easy to be misdiagnosed as lymphoplasmacyte-rich meningioma,chronic inflammatory disease,etc.HE staining of permanent paraffin section and immunohistochemical staining are helpful for its differentiation.

关 键 词：磁共振成像 中枢神经系统Rosai-Dorfman病 免疫组织化学 病例报道 

分 类 号：R365[医药卫生—病理学]