脱髓鞘假瘤临床病理观察

Clinical patho- observation on demyelinate pseudinoma

目的探讨脱髓鞘假瘤（DPT）的临床病理特点、诊断及鉴别诊断。方法回顾分析1例DPT的临床病史，影像学资料，对其进行光镜观察、组织化学及免疫组织化学染色，并复习有关文献。结果显微镜下病变区脑组织疏松，可见大量单核巨噬细胞弥漫分布，多量成熟淋巴细胞围绕在血管周围呈袖套状浸润。髓鞘及轴索染色显示髓鞘脱失，轴索仍保留，胶质细胞增生，并见到绕在血管周围呈袖套状浸润。髓鞘及轴索染色显示髓鞘脱失，轴索仍保留，胶质细胞增生，并见到散在分布的Creutzfeuldt细胞。免疫组化染色，巨噬细胞CD68弥漫强阳性，胶质细胞GFAP散在阳性，淋巴细胞CD45RO阳性，CD20散在阳性。结论DPT是1种中枢神经系统的脱髓鞘病变，易误诊为颅内其它疾病，正确认识十分重要，明确诊断可避免不必要和过度的治疗。

Objective To investigate the elinicalpathologieal features,diagnosis and differential diagnosis ofdemyelinating pseudotumor（DPT）. Methods One ease of DPT were respectively evaluated including the clinical features and image data, then studied by microscope, histochemistry and immunohistochemistry, and literature reviewed. Results Light mieruseope showed brain tissue was loosen,accompanied with plenty of mononuclear maerophages,A large number of mature lymphocytes infiltrated the vas- cular like coatsleeve.Absence of myelin with relative preservation of axons could be seen. Gliocytes proliferation and Creutafeuldt cells are also found. Immunostaining showed that maerophagocytes were positive for CD68, glial cells were focally positive for CFAP, leukomonocyte expressed CD45RO and CD20. Conclusion DPT is a demyelinating disease of central nervous system, and easy misdiagnosis for other intracalvarium disease. It is important to be recognized, definite diagnosis could avoid unconscionable therapy.