原发性中枢神经系统淋巴瘤9例浸润播散方式的临床病理观察

目的 探讨原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)在脑组织内浸润播散的方式.方法 复习9例PCNSL的临床病理资料,重点观察其在脑组织内浸润播散方式.结果 9例PCNSL中,8例为手术标本,1例为尸解标本,病理类型均为非霍奇金淋巴瘤,8例为弥漫大B细胞淋巴瘤,1例为非特异性外周T细胞淋巴瘤,中位年龄57岁,观察到3种基本浸润和播散方式:(1)沿血管周隙浸润,破坏血管周隙在血管周围浸润,侵入血管壁呈血管炎状改变,使血管腔闭塞.(2)沿神经束间浸润,在大脑灰质层和小脑分子层形成单个或数个细胞与脑表面垂直的条索向脑表面软脑膜下浸润.(3)上述两种方式浸润的瘤细胞最终进入脑皮质浅层和蛛网膜下腔.结论 PCNSL沿血管周隙、血管周围、神经纤维间隙等结构浸润至脑皮层浅层和蛛网膜下隙,并进一步播散.

The invasion and dissemination of primary central nervous system lymphoma

Purpose To investigate the route of invasion and dissemination of primary central nervous system lymphoma.Methods Pathological patterns of invasion and dissemination of 9 cases of primary central nervous system lymphoma were analyzed by HE,immunological and reticular staining.Results Three invasive patterns were found first,invasion in the perivascular space or around the vascular where the tumor cells destoryed the perivascular space,so much as into the wall of vascular.Second,lymphoma cell infiltrated along nerve fiber.Finally,the tumor cells arrive at the surface of cortex and subarachnoid space.Conclusions The tumor migrates to the surface of cortex and subarachnoid space along vascular and nerve fiber,then starts from here and scatters all over the central nervous system.