原发性中枢神经系统淋巴瘤的诊治及误诊分析

Diagnosis, treatment and misdiagnosis analysis of primary central nervous system lymphoma

目的探讨原发性中枢神经系统淋巴瘤（PCNSL）的诊治及误诊原因。方法回顾性分析经术后病理证实的19例PCNSL患者的临床资料。结果PCNSL以中老年人多见，临床表现复杂多样，病程短，病情进展快。MRI增强扫描病灶多呈均匀明显强化，可单发或多发。19例中术前MRI诊断正确者10例，误诊9例，误诊率为47％。单纯手术7例，术后全脑放疗8例，联合放化疗4例，联合治疗的患者中位生存期明显延长。结论PCNSL单纯手术治疗效果较差，采用包括手术和放化疗在内的综合治疗可提高疗效。PCNSL临床表现无特征性，影像学特征不典型，是导致误诊的主要原因。

Objective To explore the diagnosis, treatment and misdiagnosed reasons of primary central nervous system lymphoma （PCNSL）. Methods The clinical data of 19 cases with primary central nervous system lymphoma were analyzed retrospectively. Results These patients were middle or old age, with variable clinical features, short course of disease and a rapid process. Enhanced scanning showed the lesion was contrasted evenly and obviously with solitary or multiple. Among the 19 cases, 10 cases were correctly confirmed on MRI, but 9 cases were failed, with the misdiagnosis rate of 47%. 7 patients only underwent surgery and 8 accepted whale brain radiotherapy after operation. The last 4 patients were given combined therapy including resection, radiotherapy and chemotherapy. The median survival of patients who accepted combined therapy was significantly longer than who accepted surgery alone or postoperative radiotherapy. Conclusions The effect of treatment was poor with surgery alone, and it is critical to use combined therapy including operation, radiotherapy and chemotherapy to elevate therapeutic effect. It was contributed to misdiagnosis since PCNSL showed no characteristic clinical features and no typical radiographic manifestations.