原发性中枢神经系统恶性淋巴瘤

Primary malignant central nervous system lymphoma: a study of 15 cases

目的 分析原发性中枢神经系统恶性淋巴瘤 (PML CNS)的临床及影像学表现与病理所见 ,加深对本病的认识。方法 回顾分析 1989年 1月至 1999年 7月经病理结果证实的 15例PML CNS病例的临床、影像学及病理检查结果。结果 PML CNS临床表现多变 ,但其主要临床表现为颅内压增高和神经功能缺损 (肢体无力、言语障碍和癫痫发作等 ) ,半数以上的病人有头痛、视乳头水肿等颅内压增高的表现 ,易误诊为其他脑瘤 ;约 2 0 %的病人表现类似脱髓鞘疾病 ,易误诊为多发性硬化。结论 综合分析临床及影像学检查结果 ,有助于提高本病的诊断率 ;活检是确诊的必要手段。

Objective To investigate the clinical, imaging and pathological findings of the primary (CNS) lymphoma in patients without AIDS. Methods The clinical, laboratory, neuroradiological and pathological data of such 15 cases were analysed. Results The clinical features of the primary malignant lymphoma of CNS are variable,however,more than half of patients were presented with an increased intracranial pressure and a neurologic dysfunction, such as weakness of limbs,speech changes and seizures. These symptoms were always misdiagnosed as some other tumors.Examination of CSF revealed a mild or intermediate increase of protein in all patients by way of lumbar punctures. Imaging examinations by CT and MRI both showed solitary or multiple masses of tumor located more likely in the frontal and temporal lobes. Only 20% patients mimiced the demyelineting disease and were misdiagnosed as multiply sclerosis. Conclusions Patients with such CNS lymphoma usually do not present the characteristically clinical manifestations or findings in the imaging scanning. Brain biopsy may be a method more reliable to confirm this disease and be important for improving the prognosis of patients.