中枢神经系统原发性恶性淋巴瘤──附24例临床光镜、电镜及免疫组化研究

本文报告２４例原发于中枢神经系统的恶性淋巴瘤（ＭＬＣＮＳ）。以光镜、电镜和免疫组化进行观察，所得结果与临床资料、随访等对比分析，发现该瘤早、中期瘤细胞围血管分布，并沿Ｖｉｒｃｈｏｗ－Ｒｏｂｉｎ（ＶＲ）间隙扩展；晚期病变弥漫，但不均匀，无滤泡形成，瘤细胞彼此不粘聚。免疫标记及电镜检查，多数为Ｂ细胞起源，少数为组织细胞起源。临床以颅内压增高症状为主，病程多较短。ＣＴ示单灶，少数为多灶病变，呈高密、等密或疏密混合块影，周围可见轻度水肿带，常拟诊为胶质瘤或转移瘤而手术。随访结果表明，该瘤预后差，多于短期内死亡，且较颅外相同的组织学类型更差。另就病因、起源及病理鉴别诊断作了讨论。

Primary Malignant Lymphoma of the Central Nervous System

Twenty-four cases of primary malignant lymphoma of the central nervous system(MLCUS) are reported in the article. Through observation by light microscope,electron microscope (EM) and immunohistochemistry and contrast analysis of the results,the clinical dataand the follow-up,it was found that in the early and mid--term stages tumor cells spreadedaround the vessels and expanded along the Vichow Robin space;In the advanced stage pathologic changes were diffuse but not regular. No follicles were formed, no adhesive aggregationwas found among the tumor cells. By immunohistochemistry and EM examination, it wasfound that most of the tumor cells were derived from B cells,and few from histocytes. Thechief clinical symptom was presented as intracranial hypertension and the course was generally shorter. CT showed that in most of the cases,the tumors were monofocal and the few exhibited multifocal, displaying the lump with high density, equidensity and mixed densityaround it,the minimal hydropic zone could be found,the operation was often done because ofmistaking it as glioma or metastatic tumor. The follow-up data indicated that the prognosis ofthe MLCNS was poor and most of the cases died within a short period,and compared withthe same histotype of extra-cramal tumors,the prognosis was poorer. Additionally, the etiology,the origin and the differential diagnosis in pathology are also discussed.