第500例--双髋关节疼痛、头痛、复视  

The 500th case:pain in both hip joints,headache,and diplopia

作　　者：张楠楠 段彦龙[1] 王卉 张宁宁[3] 杨菁[1] 张梦[1] 李楠[1] 黄爽[1] 张楠[1] 金玲[1] Nannan Zhang;Yanlong Duan;Hui Wang;Ningning Zhang;Jing Yang;Meng Zhang;Nan Li;Shuang Huang;Nan Zhang;Ling Jin(Medical Oncology Department,Pediatric Oncology Center,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing Key Laboratory of Pediatric Hematology Oncology,Key Laboratory of Major Diseases in Children,Ministry of Education,Beijing 100045,China;Clinical Laboratory,Hebei Yanda Ludaopei Hospital,Yanjiao 065201,China;Pediatric Radiology Center,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院肿瘤内科、儿童肿瘤中心、儿童血液病与肿瘤分子分型北京市重点实验室、儿童肿瘤国家临床重点专科、儿科重大疾病研究教育部重点实验室,北京100045 [2]河北燕达陆道培医院检验科,燕郊065201 [3]国家儿童医学中心、首都医科大学附属北京儿童医院儿童影像中心,北京100045

出　　处：《中华内科杂志》2023年第2期232-236,共5页Chinese Journal of Internal Medicine

摘　　要：患儿男,5岁3个月,主因双髋关节疼痛40 d,间断头痛、复视24 d就诊。查体无明确阳性体征,神经系统未见明显异常。影像学仅有颅脑及脊髓的异常。脑脊液(CSF)常规:白细胞总数升高,以单个核细胞为主。生化检查:糖及氯化物正常,蛋白增高。考虑中枢神经系统感染可能,予抗细菌、抗病毒治疗效果欠佳。进一步完善CSF免疫分型示成熟B细胞淋巴瘤表型,全身其他部位未见肿瘤浸润,最终诊断为原发中枢神经系统淋巴瘤(PCNSL)。按CNCL-2017-成熟B细胞淋巴瘤方案化疗后达到完全缓解,现已完成全部化疗,处于持续完全缓解状态,仍在随访中。临床医生应提高对儿童PCNSL的认识与重视。A male child,aged 5 years and 3 months,was admitted to the Oncology Department with a history of pain in both hip joints,headache,and diplopia lasting for 40 days.Physical examination did not reveal definitive signs or obvious abnormalities in the nervous system.Imaging studies showed only abnormalities in the craniocerebrum and spinal cord.Routine cerebrospinal fluid(CSF)analysis revealed elevation in the total number of white blood cells,mainly mononuclear cells.Biochemical analysis of CSF showed normal glucose and chloride levels,and increased protein concentrations.The possibility of central nervous system(CNS)infection was initially considered.Subsequently,antibacterial and antiviral therapy was administered;however,this treatment was ineffective.Further examination of CSF through immunophenotyping revealed mature B-cell lymphoma with CNS involvement;there were no neoplastic lesions detected elsewhere in the body.Thus,the patient was diagnosed with primary central nervous system lymphoma(PCNSL).Complete remission was achieved after chemotherapy with the CNCL-2017-mature B-cell lymphoma regimen.Thus far,all chemotherapy cycles have been completed,the patient remains in complete remission,and the follow-up is ongoing.Clinicians should pay close attention to PCNSL in children.

关 键 词：儿童 淋巴瘤 诊断 治疗 

分 类 号：R726.8[医药卫生—儿科]