原发颅内淋巴瘤影像与病理对照分析胡忠文

原发颅内淋巴瘤影像与病理对照分析

胡忠文

（吉安县中医院影像科，江西

吉安343000）

摘

要：目的：结合病理资料，分析原发性中枢神经系统淋巴瘤的影像表现，旨在提高对其影像表现的认识。方

法：结合影像、病理特征分析15例颅内原发性淋巴瘤。结果：15例患者男ʒ女=8ʒ7，发现21个病灶，其中12例为单发，3例为多发。病灶呈为类圆形13个，“尖角征”7个，“缺口征”5个，“握拳征”1个，坏死囊变4个。其中CT 扫描9例，高密度2个，稍高密度1个，稍低密度1个，等密度5个。T1WI 均呈稍低或等信号，T2WI 呈等或稍高信号13例，高信号2例。瘤周水肿与占位效应轻、中度14例，重度1例。团块状和结节状均匀明显强化13例，花环样及环样2例。坏死囊变4例。术中血供丰富4例，11例一般。大体病理，多为质软灰红色，血供一般，质脆1例。镜下肿瘤细胞呈弥漫密集分布，瘤细胞大小较一致，胞质及水分少，核大，可见瘤细胞围绕血管呈袖套样浸润，网状纤维染色显示纤维结构较丰富。结论：原发性颅内淋巴瘤有某些独特影像特征，可提高本病的术前诊断。

关键词：淋巴瘤，原发性；PCNSL ；CT ；MRI 中图分类号：R733．1

文献标志码：A

文章编号：1001－5779（2012）05－0824－03

Primary central nervous system lymphoma with surgical pathology image contrast analysis

HU Zhong-wen

（Hospital of Traditional Chinese Medicine of Ji＇a n County ，Ji＇a n ，Jiangxi 343000）

Abstract ：Objective ：Through the imaging data to analyze and summarize the pathologically ，in order to improve the pri-mary central nervous system lymphoma diagnosis．Method ：Combining with the imaging data and pathological features to analyse 15cases of intracranial primary lymphoma．Results ：In 15cases ，male ：female =8ʒ7．21tumors were found ，12cases were single ，3cases were multiple．13tumors are like circular ，“pointed levy ”7，“gap levy ”5，“clench fist levy ”1．Four cases were necrotic and capsule．9cases had CT imaging data．High density 2，a little high density 1，low density 1，5medium density．All focus were lower or medium signal on T1WI ，13case are medium or a little high signal on T2WI ，and high signal were 2cases．Light or medium mass effect were 13cases ，and 1case was heavy．13of them demon-strated homogeneous enhancement as mass or nodule ，

while 2cases as annularity．4cases were necrosis．4cases were rich blood supply ，11cases were general in operations．In pathology ，many for mass were soft ，just one was fragile．The colour of mass were pinkish-grey．Most were general blood supply．Through microscope ，the cancer cells concentrated distribu-tion ，the size is consistent．The cytoplasm and moisture were less ，and big nuclear．The cancer cells grew around the vas-cular as oversleeve．Reticular fiber dyeing shows cancer were rich fibre structure．Conclusion ：Most PCNSL have typical MRI characteristics ，which is helpful for the correct diagnosis of PCNSL preoperatively．

Key words ：lymphoma ；primary ；Primary central nervous system lymphoma ；magnetic resonance image ；computed tomo-graphy

原发性中枢神经系统淋巴瘤（Primary central nervous sys-tem lymphoma ，

PCNSL ）约占所有颅内肿瘤总数的0．8% 1．5%，占全身恶性淋巴瘤的0．2% 2%。但随着获得性免疫缺陷综合症（AIDS ）和接受免疫抑制治疗患者的增多，本病发生率有增加的趋势。现对其影像病理资料进行分析总结，以提高对该病的认识。

1

材料与方法

1．1

研究对象

搜集2000 2010年经手术和病理证实的

原发脑内恶性淋巴瘤15例，其中男8例，女7例。年龄最大

75岁，最小40岁，中位年龄55岁。临床上患者多因头痛头晕，肢体功能障碍等中枢神经系统症状就诊。1．2

扫描方法

MR 扫描采用GE 1．5T 超导型磁共振成像

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428—第32卷第6期赣南医学院学报

Vol ．32NO ．62012年12月JOURNAL OF GANNAN MEDICAL UNIVERSITY DEC ．2012