Chen Yanxing, Lin Caixiu, Zhang Baorong
Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Oncol. 2019 Apr 12;9:266. doi: 10.3389/fonc.2019.00266. eCollection 2019.
Identifying lymphoma as the cause of neurological disease is diagnostically challenging when the clinical manifestations are atypical. We report an unusual case of a previously healthy immunocompetent 67-years-old man presenting with acute onset of symptoms of myelopathy and mild personality changes. Magnetic resonance imaging (MRI) revealed multifocal periventricular lesions and longitudinally extensive transverse myelitis (LETM). He had very good response to corticosteroids and was in remission for over 6 months. Repeat MRI showed an unexpected mass lesion in the brain which was later confirmed by brain biopsy as diffuse large B cell lymphoma. Subsequent FDG-PET/CT revealed systemic disease with lymphonodal and testicular manifestations (Stage IV disease). It is therefore important to consider lymphoma as a differential diagnosis in patients with LETM and demyelinating lesions in the brain.
当临床表现不典型时，将淋巴瘤确定为神经疾病的病因在诊断上具有挑战性。我们报告了一例不寻常的病例，一名67岁既往健康的免疫功能正常男性，急性起病，出现脊髓病症状和轻度人格改变。磁共振成像（MRI）显示多灶性脑室周围病变和纵向广泛横贯性脊髓炎（LETM）。他对皮质类固醇反应良好，缓解超过6个月。复查MRI显示脑部意外出现肿块病变，后来经脑活检证实为弥漫性大B细胞淋巴瘤。随后的氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）显示存在系统性疾病，伴有淋巴结和睾丸表现（IV期疾病）。因此，对于患有LETM和脑部脱髓鞘病变的患者，将淋巴瘤作为鉴别诊断是很重要的。
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