Clinicopathological analysis of misdiagnosed tumefactive demyelinating lesions and primary central nervous system lymphoma
10.3760/cma.j.issn.1006-7876.2015.09.005
- VernacularTitle:颅内肿瘤样脱髓鞘病与原发性中枢神经系统淋巴瘤临床误诊病理分析
- Author:
Chenjing SUN
;
Liu HONG
;
Jianguo LIU
;
Ping LU
;
Qiuping GUI
;
Xiaokun QI
- Publication Type:Journal Article
- Keywords:
Demyelinating diseases;
Central nervous system neoplasms;
Lymphoma;
Diagnostic errors
- From:
Chinese Journal of Neurology
2015;48(9):757-762
- CountryChina
- Language:Chinese
-
Abstract:
Objective To improve differential diagnosis of tumefactive demyelinating lesions (TDL) and primary central nervous system lymphoma (PCNSL) by analyzing the clinicopathological features of the diseases.Methods The clinical features,neuroimaging findings and pathological characteristics of 4 patients with pathologically proven TDL and 9 patients with pathologically proven PCNSL were retrospectively analyzed.Computer tomography and magnetic resonance imaging were used for neuroimaging studies.The hematoxylin and eosin staining,Luxol Fast Blue staining and immunohistochemistry were used for pathological studies.Results (1) The features of lesions on brain imaging scan:CT in TDL patients showed low density.Enhanced MRI demonstrations were different in different courses:3 cases with ring enhancement,1 case with spotty strengthen;5 PCNSL cases showed hyperdensity in CT,1 case showed isodensity,and 3 cases low-density.MRI showed enhancement of uniform enhancement in PCNSL patients.(2) The features of lesions on pathology:the plaques of lesions in TDL patients were characterized by massive demyelination with relatively axonal preservation associated with prominent astrocytosis and profound infiltrates composed.Typical pathological features in PCNSL cases were that tumor cells around blood vessels showed the cuff-like arrangement.Due to use of hormones and other causes,pathological demonstrations of a part of PCNSL cases were atypical,which were easily confused with TDL.There were 4 cases with more than one biopsy for diagnosis.Conclusions (1) PCNSL with low or equal density in CT needs to be differentiated with TDL.(2) The pathological features of some cases of PCNSL after hormone therapy were similar to TDL.It is better not to use hormone before definite diagnosis.(3) The pathology of PCNSL may be related to the progression of the disease.Some of patients need to be re-biopsied.It is important to combine clinical imaging and pathology for diagnosis of the disease,and attention should be paid to followup.
