病例报告:脑下垂体脱髓化病变前的淋巴瘤发生在中枢神经系统之外
Narushi Sugii1, Hiroyoshi Kino1, Tetsu Suzuki2
1Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
Frontiers in oncology
|October 8, 2025
概括
一个罕见的病例显示大脑病变,最初模仿脱髓化,先前是全身扩散大B细胞淋巴瘤 (DLBCL). 这凸显了在神经病例中考虑哨兵病变的重要性,即使没有中枢神经系统淋巴瘤.
科学领域:
- 神经学 神经学
- 在瘤学瘤学.
- 病理学 病理学 病理学
背景情况:
- 非瘤性脱髓化脑病变 (哨兵病变) 可以先于初级中枢神经系统淋巴瘤 (PCNSL).
- 与神经外淋巴瘤相关的脑哨兵病变以前没有被记录.
研究的目的:
- 报告脑哨兵病变的第一个病例,先前是全身扩散型大B细胞淋巴瘤 (DLBCL).
- 讨论这种病变的诊断挑战和潜在机制.
主要方法:
- 一个76岁的女性患有视力障碍的病例报告.
- 磁共振成像 (MRI) 和下丘脑病变的活检显示炎症性脱髓化.
- 随后通过对头骨损伤的活检诊断全身DLBCL.
主要成果:
- 最初的大脑病变对类固醇治疗反应良好,这表明炎症性脱髓化.
- 患者后来发展出全身DLBCL,一种非生殖中心B细胞类亚型.
- 尽管系统性淋巴瘤的进展,大脑病变没有复发.
结论:
- 这一案例代表了首次记录了系统DLBCL之前的大脑哨兵病变的记录.
- 这些发现表明与PCNSL哨兵病变有相似之处,包括类固醇反应和T淋巴细胞透.
- 强调需要考虑 sentinel 病变在瘤活性炎症性脱髓化,特别是T-淋巴细胞主导透,用于早期诊断.
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