摘要
目的探讨原发中枢神经系统淋巴瘤(primary central nervous system lymphomas,PCNSL)临床特征及常见误诊疾病和误诊原因。方法回顾性分析2018年1月—2019年1月我院收治的经立体定向活检术后病理检查确诊的98例PCNSL临床资料。结果98例中首诊误诊率为40.82%,其中男25例,女15例;年龄26~80(57.5±11.1)岁;首发症状:局灶性神经功能缺损16例,头痛10例,乏力、嗜睡等非特异性症状7例,头晕4例,认知功能损害3例;病程4~530(91.4±135.4)d;病变部位:幕上28例,全脑9例,幕下3例;病灶个数:单发19例,多发21例;MRI特征性影像17例;瘤周水肿程度:轻度2例,中度10例,重度28例。与非误诊患者比较,二者在年龄、性别、首发症状、颅内病变部位、颅内病灶个数、特征性影像学表现、瘤周水肿程度方面比较差异无统计学意义(P>0.05)。首诊误诊疾病包括颅内肿瘤16例(胶质瘤10例、转移瘤5例、室管膜瘤1例),脑血管疾病14例(脑梗死12例、脑出血及颅内静脉血栓形成各1例),眼科疾病4例,脑积水、脑白质病变、神经性耳聋及抑郁症各1例,首诊无异常2例;均经术后病理确诊为弥漫大B细胞淋巴瘤,其中来源于非生发中心36例,生发中心3例,无法分类1例;误诊时间为10~390(68.7±97.1)d。结论PCNSL误诊率较高,无特征性临床表现,MRI增强扫描有助于诊断,但确诊需依靠立体定向活检术后病理检查。提高临床医师对该疾病的认识、加强多学科合作可减少本病误诊的发生。
Objective This study aimed to describe the clinical features,common misdiagnosis and causes of misdiagnosis with primary central nervous system lymphoma(PCNSL).Methods The clinical data of 98 patients with pathologically confirmed PCNSL after stereotactic biopsy that were treated in our hospital from January 2018 to January 2019 were retrospectively analyzed.Results Of 98 patients,40 patients were misdiagnosed initially,with a misdiagnosis rate of 40.82%.In the misdiagnosis group there were 25 males and 15 females with an age range from 26 to 80 years(57.5±11.1).Initial symptoms were composed of focal neurological deficit in 16 cases,headache in 10 cases,non-specific symptoms such as fatigue and drowsiness in 7 cases,dizziness in 4 cases and cognitive impairment in 3 cases.The course of the disease was 4 to 530(91.4±135.4)days.Twenty-eight cases with lesions located in supratentorial region,3 cases with infratentorial lesions and 9 cases of whole brain involvement were detected among the misdiagnosed patients,together with single intracranial lesions in 19 cases and multiple lesions in 21 cases.Characteristic imaging appearance on MRI was detected in 17 cases,with 2 cases of mild,10 cases of moderate and 28 cases of severe peritumoral edema.There was no statistical difference between the groups in age,sex,initial symptoms,location as well as the number of intracranial lesions,characteristic imaging appearance and degree of peritumoral edema(P>0.05).The initially misdiagnosed diseases included 16 cases of intracranial tumors(10 cases of glioma,5 cases of metastatic tumor,1 case of ependymoma),14 cases of cerebrovascular diseases(12 cases of cerebral infarction,1 case of cerebral hemorrhage,1 case of intracranial venous thrombosis),4 cases of ophthalmology,1 case of hydrocephalus,1 case of white matter lesion,1 case of nervous deafness,1 case of depression and 2 cases of normal diagnosis.All those misdiagnosed cases were pathologically diagnosed as diffuse large B-cell lymphoma,including 36 cases from non-germ center,3 cases from germ center and 1 case unclassified.Duration lasting from misdiagnosis to pathological diagnosis ranged from 10 to 390(68.7±97.1)days.Conclusion We identified high rates of misdiagnosis of PCNSL with no characteristic clinical manifestations.Contrast-enhanced MRI is useful for the diagnosis of PCNSL,and pathological diagnosis after stereotactic brain biopsy is required for confirmation of diagnosis.Occurrence of misdiagnosis could be reduced after improvement of clinicians'understanding of PCNSL and multi-disciplinary cooperation.
作者
任斌
程岗
郭志峰
方佳
王亚明
曹卫东
张剑宁
REN Bin;CHENG Gang;GUO Zhi-feng;FANG Jia;WANG Ya-ming;CAO Wei-dong;ZHANG Jian-ning(Department of Neurosurgery,PLA General Hospital,Beijing 100048,China)
出处
《临床误诊误治》
2020年第12期21-24,共4页
Clinical Misdiagnosis & Mistherapy
基金
国家自然科学基金项目(81572899)。
