【双语病例】脑炎性假瘤

Description 病史简介

A 39-year-old woman with gradual-onset right-sided headache for last 2 months. Nonhypertensive, nondiabetic, no history of tuberculosis.

39岁女性,右侧头痛2月,逐渐加重。无高血压、糖尿病、结核病史。

【双语病例】脑炎性假瘤

【双语病例】脑炎性假瘤

【双语病例】脑炎性假瘤

【双语病例】脑炎性假瘤

术后复查:

【双语病例】脑炎性假瘤

术后6个月复查:

【双语病例】脑炎性假瘤

Legends 图例

Axial T1WI (A), coronal T2WI (B), and postcontrast axial and coronal T1WI (C, D) demonstrate an irregularly shaped right frontal lesion isointense on T1 and centrally hyperintense with hypointense rim on T2, and rim-enhancement. Significant perilesional edema and mass effect are present. Immediate postoperative postcontrast T1W I (E) axial image shows a small residual rim-enhancing lesion. At 6-month follow-up on steroid therapy, axial postcontrast T1WI (F) shows postoperative encephalomalacic changes. No evidence of residual lesion is noted, suggesting complete resolution.

横断位T1WI、冠状位T2WI及增强扫描横断位、冠状位T1WI示右侧额叶不规则形异常信号影,T1WI呈等信号,T2WI呈中央高信号伴周边低信号环,增强扫描不规则环形强化。瘤周可见大片水肿带,占位效应明显。

术后立即增强扫描T1WI可见小环形强化灶,考虑为术后残留。

类固醇治疗6周后复查T1WI增强扫描示脑术后软化灶,未见明显术后残余,考虑病变完全吸收。

【双语病例】脑炎性假瘤
Histopathology: Plasma cell infiltration with few lymphocytes and macrophages. No signs of cellular atypia. No evidence of caseous necrosis. Few areas of fibrotic tissue were noted in depth.

病理:浆细胞浸润,并可见少量淋巴细胞和巨噬细胞。未见明显异型细胞。无明显干酪样坏死。深部部分区域为纤维组织。

Inflammatory Pseudotumor (IPT) of the Brain

脑炎性假瘤

Background 背景

IPT, or plasma cell granuloma, is a rare mass-like proliferation of polyclonal chronic inflammatory cells, predominantly plasma cells. The underlying etiology is poorly understood. These lesions are important benign mimics of aggressive neoplastic processes.

脑炎性假瘤,或浆细胞肉芽肿,是一种多克隆慢性炎性细胞增生性病变,以浆细胞增生为主,其表现类似肿瘤,病因尚不完全明确。该病为良性病变,但易于侵袭性肿瘤相混淆。

Clinical Information 临床特征

Usually affects younger patients than does glioblastoma multiforme. May present with varied neurologic symptoms (headache, seizures, focal neurologic deficits).

相对于多形性胶质母细胞瘤来说,IPT多发生于年轻人。临床表现为神经系统表现,如头痛、癫痫、局部神经功能异常。

Key Diagnostic Feature 诊断要点

  • The majority of intracranial IPTs will demonstrate a dural/meningeal attachment rather than being primarily intra-axial

    大多数的IPT发生于脑内、侵犯硬脑膜或软脑膜,很少发生于脑外。

  • Imaging features resemble an aggressive mass lesion with enhancement and mass effect.

    影像学表现类似侵袭性肿瘤,增强扫描可见强化,占位效应明显。

  • Definitive diagnosis is by histopathology.

    最终确诊需要依靠病理。

DDx 鉴别诊断

  • Glioblastoma multiforme

    多形性胶质母细胞瘤

  • Primary CNS lymphoma

    原发性中枢神经系统淋巴瘤

  • Sarcoidosis

    结节病

  • Tuberculoma

    结核

Treatment 治疗

Complete surgical excision. Steroids /- radiotherapy may be used as alternative or adjuvant therapies for complete resolution.

首选手术全切。类固醇治疗和(或)放疗可以作为次选治疗手段,或作为手术切除的辅助治疗。

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