中枢神经系统的初级大B细胞淋巴瘤在最初呈现时模仿炎症性髓炎
Satoshi Ichikawa1,2, Katsuki Imanishi1,3, Hikaru Kumagai1,2
1Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Journal of clinical and experimental hematopathology : JCEH
|November 30, 2025
概括
主要中枢神经系统大B细胞淋巴瘤 (PCNS-LBCL) 很少最初在脊髓中出现,模仿炎症性疾病. 即使有哨兵病变,早期识别PCNS-LBCL对于及时诊断和改善患者的治疗结果至关重要.
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:
- 主要中枢神经系统大B细胞淋巴瘤 (PCNS-LBCL) 是一种罕见的外节淋巴瘤,主要影响大脑.
- 脊髓干扰作为PCNS-LBCL的初始表现是非常罕见的,在诊断上具有挑战性,通常模仿炎症性脱髓化疾病.
研究的目的:
- 要突出PCNS-LBCL的诊断复杂性,呈现出孤立的脊髓干扰和类固醇反应.
- 强调考虑PCNS-LBCL在不响应免疫治疗的复发性脑膜炎病例中的重要性.
主要方法:
- 一个50多岁的男性患者的病例报告,出现了宫髓炎的初始症状.
- 尽管使用皮质类固醇和ofatumumab治疗,神经系统的恶化,随后进行立体脑部活检.
- 脑脊髓液分析显示了高的互白素-10水平.
主要成果:
- 立体脑活检证实了PCNS-LBCL.
- 最初的脊髓损伤被认为可能是哨兵损伤.
- 脑脊液中高水平的白内素-10水平在化疗时降低,与临床改善相关.
结论:
- 呈现PCNS-LBCL与孤立的脊髓干涉和类固醇反应,可以延迟诊断.
- 临床医生应怀疑中枢神经系统淋巴瘤在耐火性脑膜炎和考虑活检.
- 意识到哨兵病变可能有助于早期识别PCNS-LBCL并改善结果.
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