Diagnosis of central nervous system lymphoma
Time:2009-11-05 13:51 Author:admin Hits:
Lymphoma, non-specific clinical manifestations, such as non-cytology and histology data, preoperative diagnosis very difficult. Epidemiological survey found that three categories of persons who have susceptibility: ① organ transplant recipients; ② AIDS; ③ those with congenital immune deficiency (such as systemic lupus erythematosus, EB virus infection and rheumatoid, etc.). The above three categories of persons suffering from diseases of central nervous system to take into account the possibility of this disease. Patients with symptoms of intracranial hypertension, but also combined paresis or mental disorder, peripheral blood lymphocytes in WBC ratio increased cranial CT and MRI showed multiple periventricular midline or diffuse growth of lesions, the diagnosis of the basic set up. However, with glioblastoma, meningioma and other identification, can be lumbar puncture to collect cerebrospinal fluid line stereotactic biopsy cytology or other laboratory examinations, in order to confirm the diagnosis.
Differential Diagnosis:
1. Metastases were located at the junction of gray matter, CT, mostly low-density non-enhanced scan, MRI imaging for long T1 long T2 abnormal signal, while lymphomas are mostly low or T2 signals such as T1, etc.. Injection of contrast agent, the lesion was obviously enhanced nodular lesions are often large with central necrosis, and in the relatively rare lymphoma, metastatic tumor surrounding edema is very obvious. Some patients can provide a history of cancer outside the central nervous system.
2. Gliomas glioma MRI showed the majority of long T1 long T2 signal anomalies. The infiltrative growth characteristics of obvious ill-defined, certain types of glioma, such as small sticks of glial cell tumors have calcification, enhanced glioblastoma multi irregular, like a ring or branch.
3. Meningiomas were located near the surface of the brain meninges part, the state class round the border was aware of signs around the gray push. Non-enhanced CT and MRI for high-density T1 and so on for the other characteristics of T2 signal. After the injection of contrast agent, tumor even enhanced, there is meningeal "tail sign." It should be noted that the meningeal "tail sign" is not unique to meningioma, any invasion and meningeal disease, have a "tail sign" may be.
4. Infectious disease age of onset is relatively young, some have a history of fever. Bacterial infections lesions enhanced scan, mostly ring-like enhancement, multiple sclerosis and other, mostly patchy to strengthen.
Differential Diagnosis:
1. Metastases were located at the junction of gray matter, CT, mostly low-density non-enhanced scan, MRI imaging for long T1 long T2 abnormal signal, while lymphomas are mostly low or T2 signals such as T1, etc.. Injection of contrast agent, the lesion was obviously enhanced nodular lesions are often large with central necrosis, and in the relatively rare lymphoma, metastatic tumor surrounding edema is very obvious. Some patients can provide a history of cancer outside the central nervous system.
2. Gliomas glioma MRI showed the majority of long T1 long T2 signal anomalies. The infiltrative growth characteristics of obvious ill-defined, certain types of glioma, such as small sticks of glial cell tumors have calcification, enhanced glioblastoma multi irregular, like a ring or branch.
3. Meningiomas were located near the surface of the brain meninges part, the state class round the border was aware of signs around the gray push. Non-enhanced CT and MRI for high-density T1 and so on for the other characteristics of T2 signal. After the injection of contrast agent, tumor even enhanced, there is meningeal "tail sign." It should be noted that the meningeal "tail sign" is not unique to meningioma, any invasion and meningeal disease, have a "tail sign" may be.
4. Infectious disease age of onset is relatively young, some have a history of fever. Bacterial infections lesions enhanced scan, mostly ring-like enhancement, multiple sclerosis and other, mostly patchy to strengthen.
Laboratory examination:
1. Peripheral blood white blood cells such as lymphocytes in peripheral blood of patients could be increased. Lymphocytes increased non-specific, the reason is not very clear, but this feature can be used as an important reference for diagnosis of the disease.
2. Cerebrospinal fluid cytology in almost all patients with CSF protein content increased significantly, cell count also increased, while the sugar content often lower half of the patient's cerebrospinal fluid can be detected in tumor cells and lymphocyte count increased, which is considered to be preoperative the only way to diagnosis.
Other auxiliary check:
1. Skull X plain film 50% of patients skull plain film abnormalities, common pineal shift and signs of intracranial hypertension, rarely seen tumor calcification.
2. Electrocardiogram 80% of lymphoma patients with a normal EEG does not appear as localized or diffuse lesions.
CT scan showed 3.CT examination of high-density or iso-density blocks of shadow, although with the imaging of glioma very similar changes, but the majority of malignant lymphoma of the boundary more clearly, the application enhancer, the tumor significantly enhanced, in the between tumor and normal brain tissue edema apparent, sometimes as multiple lesions can also spread along the subependymal.
4.MRI Check MRI examination can be due to a multi-dimensional vector-crown-axis scanning, resolution of CT is higher than the advantages of intracranial malignant lymphoma in understanding the shape of relations with neighboring organizations have some strengths. Lesions in general such as TI-weighted images showed signal or lower the signal, the signal a more uniform injection of GD-DTPA, the lesion even strengthened, some patients with supratentorial ventricles of the brain adjacent ependymal enhanced, suggesting that tumor has been extended along the ependymal infiltration. There are reports that, intracranial malignant lymphoma peritumoral edema of high signal not only indicates that the parts of the brain interstitial water increased, and contain tumor cells spread along the perivascular space components.
5. Stereotactic biopsy is clear the nature of disease simplest and most effective methods, but little injury, diagnosis and treatment of patients play a decisive role.
1. Peripheral blood white blood cells such as lymphocytes in peripheral blood of patients could be increased. Lymphocytes increased non-specific, the reason is not very clear, but this feature can be used as an important reference for diagnosis of the disease.
2. Cerebrospinal fluid cytology in almost all patients with CSF protein content increased significantly, cell count also increased, while the sugar content often lower half of the patient's cerebrospinal fluid can be detected in tumor cells and lymphocyte count increased, which is considered to be preoperative the only way to diagnosis.
Other auxiliary check:
1. Skull X plain film 50% of patients skull plain film abnormalities, common pineal shift and signs of intracranial hypertension, rarely seen tumor calcification.
2. Electrocardiogram 80% of lymphoma patients with a normal EEG does not appear as localized or diffuse lesions.
CT scan showed 3.CT examination of high-density or iso-density blocks of shadow, although with the imaging of glioma very similar changes, but the majority of malignant lymphoma of the boundary more clearly, the application enhancer, the tumor significantly enhanced, in the between tumor and normal brain tissue edema apparent, sometimes as multiple lesions can also spread along the subependymal.
4.MRI Check MRI examination can be due to a multi-dimensional vector-crown-axis scanning, resolution of CT is higher than the advantages of intracranial malignant lymphoma in understanding the shape of relations with neighboring organizations have some strengths. Lesions in general such as TI-weighted images showed signal or lower the signal, the signal a more uniform injection of GD-DTPA, the lesion even strengthened, some patients with supratentorial ventricles of the brain adjacent ependymal enhanced, suggesting that tumor has been extended along the ependymal infiltration. There are reports that, intracranial malignant lymphoma peritumoral edema of high signal not only indicates that the parts of the brain interstitial water increased, and contain tumor cells spread along the perivascular space components.
5. Stereotactic biopsy is clear the nature of disease simplest and most effective methods, but little injury, diagnosis and treatment of patients play a decisive role.
