颅内浆细胞肉芽肿(附五例报告及文献复习)

Intracranial plasma cell granuloma(5 cases report and rewiew of the literature)

目的 探讨中枢神经系统浆细胞肉芽肿的诊断及治疗。方法 对我院 1997年 1月至2 0 0 2年 3月收治的 5例颅内浆细胞肉芽肿的临床资料进行回顾性分析。结果 5例病人 ,2例位于左顶叶 ,余 3例分别位于右颞叶、右额叶和枕骨大孔区 ,头CT显示为高密度 ,MRI为长或等T1、长T2信号 ,注射造影剂后明显增强。术前诊断为脑转移瘤、脑囊虫病、脑脓肿和脑膜瘤 ,术后经病理和免疫组化染色发现肿物主要由 3种成熟的细胞组成 ,即浆细胞、淋巴细胞和组织细胞 ,以浆细胞为主 ,浆细胞胞浆内κ、λ轻链均呈阳性表达。手术切除后给予激素治疗 ,预后良好。结论 颅内浆细胞肉芽肿少见 ,易引起误诊 ,免疫组化检查有助于鉴别诊断 ,手术切除和激素治疗效果较好。

Objective To explore the diagnosis and treatment of intracranial plasma cell granuloma. Methods 5 patients with intracranial plasma cell granulomas were retrospectively reviewed from January of 1997 to March of 2002. Results The lesions located at left parietal lobe in 2 patients, 3 patients with lesions located at right temporal lobe, right frontal lobe and foramen magnum, respectively. The tumors was hyperintense on CT scan. On MRI of the head , the tumors was hypointense or isointense on T1-weighted sequence, with increased signal on T2-weighted images, and contrast-enhanced after administration of gadolinium. Brain metastasis, cerebral cysticerciasis, abscess and meningioma were diagnosed before operation. In all cases, the lesions consisted of a fibrous tissue containing inflammatory cells among which plasma cells predominated. Immunohistochemical analysis for κ and λ light chains demonstrated the polyclonal nature of the plasma cells. Follow-up was favorable postoperation followed with hormone treatment.Conclusions Intracranial plasma cell granulomas are rare lesions and were always misdiagnosed in clinical, immunohistochemical analysis is helpful in differential diagnosis, hormone treatment after operation may cure the lesion.