Abstract:

Objective  To investigate the clinical features, imaging and pathological characteristics of primary central nervous system lymphoma (PCNSL) in order to increase the diagnostic accuracy of PCNSL in clinic.  Methods  A retrospective analysis of 6 cases with PCNSL confirmed by pathological and immunohistochemical examination, treated in our hospital from December 2013 to August 2014 was performed. The clinical presentations, lesion locations, imaging manifestations and histopathological features were analysed.  Results  The symptoms were various, among which headache and dizziness were frequently presented. Five cases were identified to have solitary tumor foci and the other one had multiple lesions. Among 7 lesions, 4 were located in cerebral hemisphere, one was located in cerebellum, one in lateral ventricle and one in thalamus. Moreover, 2 lesions were involved in corpus callosum. The lesions presented in roundish shape or irregular shape with clear boundary, minimal edema and mass effect. CT showed high-density of the lesions. All lesions showed iso- or slightly hypo-intense signal on T₁WI and iso- or mild hyper-intense on T₂WI, and homogeneous enhancement after contrast. All cases underwent operations. The tumors appeared flesh red or grey-white, soft and without capsules. Under microscopic examination, the tumor cells were distributed around the blood vessels as "sleeve-like" infiltration. Immune phenotype analysis showed all tumors were B-cell lymphoma.  Conclusions  PCNSL has certain imaging and pathological features and most of them are diffuse large B-cell lymphoma (DLBCL). Pathological examination and immune phenotype analysis are "gold standard" in making confirmed diagnosis.

Key words: Central nervous system neoplasms, Lymphoma, B-cell, Magnetic resonance imaging, Pathology

摘要：

目的 探讨原发性中枢神经系统淋巴瘤的临床表现、影像学和病理学特征。方法 回顾分析6 例经术后病理学检查证实的原发性中枢神经系统淋巴瘤患者的临床资料，分析其临床表现、影像学和组织病理学特征。结果 原发性中枢神经系统淋巴瘤临床表现多样，以头痛、头晕多见。6 例患者中肿瘤单发5 例、多发1 例，共7 个病灶，病灶位于大脑半球4 个、小脑1 个、侧脑室1 个、丘脑1 个，其中2 个病灶累及胼胝体。病灶多呈类圆形或不规则形，边界较清晰，肿瘤周围水肿和占位效应相对较轻。CT 显示肿瘤呈高密度，T₁WI 呈等或略低信号、T₂WI 呈等或稍高信号、增强扫描肿瘤呈均匀强化。所有患者均行手术治疗。光学显微镜观察，肿瘤细胞围绕血管周围分布，形成“袖套”样浸润；免疫组织化学表型分析，肿瘤均来源于B 淋巴细胞。结论 原发性中枢神经系统淋巴瘤影像学和病理学表现具有一定特异性，主要病理学类型为弥漫性大B 细胞淋巴瘤，组织学形态和免疫组织化学表型分析是明确诊断的“金标准”。

关键词: 中枢神经系统肿瘤, 淋巴瘤, B 细胞, 磁共振成像, 病理学