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[中枢神经系统脱髓鞘疾病的“面具”。原发性淋巴瘤]

[«Masks» of CNS demyelinating diseases. Primary lymphoma].

作者信息

Kozlova A O, Kamenskikh E M, Konovalov R N, Chekanova E O, Alifirova V M, Zakharova M N

机构信息

Research Center of Neurology, Moscow, Russia.

Siberian State Medical University, Tomsk, Russia.

出版信息

Zh Nevrol Psikhiatr Im S S Korsakova. 2024;124(7. Vyp. 2):101-108. doi: 10.17116/jnevro2024124072101.

Abstract

Primary central nervous system lymphoma (PCNSL) is a rare neoplasm that can affect the brain, eyes, and, rarely, the spinal cord. Clinical presentation and MRI findings can mimic a variety of diseases, including high-grade gliomas, infectious and granulomatous diseases, and demyelinating diseases. We describe three cases where the diagnosis of PCNSL was difficult due to an ambiguous clinical, radiological and laboratory results. The role of stereotactic biopsy remains leading in differential diagnosis; however, the invasiveness and frequent limitations of this method determine the search for additional biological markers of the disease. New evidence suggests a potential role for cerebrospinal fluid (CSF) cytokine profiles and proteomic analysis in differential diagnosis, disease progression, and treatment response.

摘要

原发性中枢神经系统淋巴瘤(PCNSL)是一种罕见的肿瘤,可累及脑、眼,很少累及脊髓。临床表现和磁共振成像(MRI)表现可模仿多种疾病,包括高级别胶质瘤、感染性和肉芽肿性疾病以及脱髓鞘疾病。我们描述了3例因临床、放射学和实验室结果不明确而难以诊断为PCNSL的病例。立体定向活检在鉴别诊断中仍起主导作用;然而,该方法的侵入性和常见局限性决定了要寻找该疾病的其他生物学标志物。新证据表明,脑脊液(CSF)细胞因子谱和蛋白质组分析在鉴别诊断、疾病进展和治疗反应中可能发挥作用。

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