貌似肿瘤的中枢神经系统脱髓鞘病

目的总结貌似肿瘤的中枢神经系统炎性脱髓鞘病病例,分析其临床、影像学及病理特点,归纳临床误诊原因并探讨诊断及鉴别诊断要点.方法分析经术后病理证实的14例临床资料,包括病史、发病情况、临床症状、体征、手术中肉眼所见,影像学包括CT/MRI表现,病理包括HE染色,Luxolfastblue(Lfb)髓鞘染色,Bodian神经纤维染色,还进行了CD68,胶质纤维酸性蛋白(GFAP)及神经丝蛋白(NF)等免疫组化染色.结果中枢神经系统脱髓鞘病临床上可出现头痛、癫等症状,急性期CT/MRI可以出现水肿等占位效应、增强后可以有环形强化,冰冻切片可以观察到胶质细胞增生等.结论中枢神经系统脱髓鞘病可以有肿瘤样的非典型性表现,临床容易造成误诊.应在临床、影像学及病理学等多方面进行鉴别诊断.

Tumor-like demyelinating disease of the central nervous system.

Objective We analyzed 14 cases of tumor-like demyelinating disease of the central nervous system(CNS) by ex-amining the Clinical materials, MRI, CT and pathologic characteristics and summarized the criterion for differential diagnosis. Methods Clinical data including history, symptom, physical signs and CT/MRI imaging were examined and analyzed. Hie specimens were stained by HE, Luxol fast blue(Lib), Bodian, CD68 and glial fibrillary acidic protein(GFAP) for pathologic examination. Results Demyelinating disease of the CNS could present clinically as tumor with symptoms such as headache and epilepsy. On CT or MRI, it could have the appearance of tumor such as edema, ring-enhancement and mass effect. On pathology, glial cell prolifera-tion could also be seen. Conclusions The clinical and neuroimaging features of demyelinating disease of the CNS may mimic neoplasm, and thus it may be difficult to establish the diagnosis. When we encounter tumor-like lesions, demyelinating disease should be considered in the differential diagnoses.