中枢神经系统病变5例病理误诊分析

Pathological misdiagnoses of the central nervous system lesions: an analysis of 5 cases

目的探讨5例误诊的中枢神经系统肿瘤和非肿瘤性病例的误诊原因及解决方案。方法复习5例误诊的中枢神经系统肿瘤和非肿瘤性病例,分析各例误诊的关键因素以及相应的鉴别诊断,提出临床病理诊断方法。结果 5例误诊的病例中,肿瘤病例4例、非肿瘤病例1例;良性病变误诊为恶性2例,恶性肿瘤误诊为良性2例,1例非肿瘤性病变误诊为良性肿瘤。其中1例良性误诊为恶性的病例因后续放疗产生了严重后果。误诊的主要原因是不能系统地认识中枢神经系统病变、不熟悉诊断标准和新进展、不注重结合影像等相关检查结果。中枢神经系统病变的病理诊断应该遵循临床、影像、组织形态、免疫表型等综合分析的方法。结论中枢神经系统病变的病理误诊并不罕见,减少误诊的解决方案是开展神经系统专科病理。

Objective To discuss the reason for the misdiagnoses of five cases of the central nervous system tumorous and non-neoplastic lesions, and to propose a reasonable solution. Methods Among the five misdiagnosed cases, four cases were tumors and one case was non-neoplastic lesion. Two benign cases were overdiagnosed as malignant tumors, whereas two malignant cases were underdiagnosed as benign tumors, one non-neoplastic lesion was misdiagnosed as benign tumor. Owing to follow-up radiotherapy, serious consequences took place in a benign case which was misdiagnosed as malignant tumor. The main reason of misdiagnoses was lack of thoroughly systemic understanding of the central nervous system lesions, unfamiliar with the diagnostic criteria and its new progress, and paid no attention to the imaging as well as other examination results. Pathological diagnoses of the central nervous system lesions should based on the comprehensive analysis of the clinical data, imaging findings, morphological features and immunohistochemieal patterns. Conclusions Pathological misdiagnoses of the central nervous system lesions are not rare events. Specialization of pathology （ such as neuropathology） may be a solution of decreasing the misdiagnosis.