Hashizume Yoshio, Yoshida Mari
Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University.
Rinsho Shinkeigaku. 2002 Nov;42(11):1121-3.
Primary central nervous system lymphoma are characterized by macroscopically the tumor mass formation in the cerebral hemisphere including basal ganglia and corpus callosum and diffuse invasion particularly in the periventricular region, and microscopically lymphoma cells proliferation around the vessels and diffuse invasion into the brain parenchyma. Secondary involvement of central nervous system by systemic lymphoma are characterized by tumor cells invasion to the meninges and cranial and spinal nerve roots and tumor cells invade to the brain parenchyma along the perivascular space. Tumor nodule formation are very rare and tumor cells are not found in the lumen of the vessels. In the cases of extradural metastasis of systemic lymphoma, in addition to spinal cord compression, secondary circulatory disturbance, particularly venous congestion are also important factor for the spinal cord damages. In intravascular malignant lymphoma, not only tumor cells proliferation in the lumen of small sized vessels, but also secondary vasculitis and fresh and old thrombus formation are important for the development of multiple infarction of central nervous system. And spinal cords particularly in the levels of lumbosacral spinal cord are dominantly involved. Recently, according to the longness of clinical course of intravascular malignant lymphomatosis, cases with tumor mass are reported and these tumor mass are very similar to that of primary central nervous system lymphoma.
原发性中枢神经系统淋巴瘤的特征在宏观上表现为在包括基底神经节和胼胝体的大脑半球形成肿瘤块,并伴有弥漫性浸润,尤其是在脑室周围区域;微观上表现为淋巴瘤细胞围绕血管增殖并弥漫性侵入脑实质。系统性淋巴瘤继发累及中枢神经系统的特征是肿瘤细胞侵犯脑膜、颅神经和脊神经根,以及肿瘤细胞沿血管周围间隙侵入脑实质。肿瘤结节形成非常罕见,血管腔内未发现肿瘤细胞。在系统性淋巴瘤硬膜外转移的病例中,除了脊髓受压外,继发性循环障碍,尤其是静脉淤血也是脊髓损伤的重要因素。在血管内恶性淋巴瘤中,不仅小血管腔内有肿瘤细胞增殖,而且继发性血管炎以及新老血栓形成对于中枢神经系统多发性梗死的发生也很重要。并且脊髓尤其是腰骶段脊髓受累为主。最近,根据血管内恶性淋巴瘤病临床病程的长短,有报道出现肿瘤块的病例,这些肿瘤块与原发性中枢神经系统淋巴瘤的肿瘤块非常相似。