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目的 探讨颅内B淋巴母细胞淋巴瘤的临床特点、误诊原因及防范措施。方法 回顾性分析2022年11月收治被误诊的1例颅内B淋巴母细胞淋巴瘤患者临床资料。结果 患者因突发言语不利就诊，经头颅CT检查后被误诊为硬膜下血肿。予相应治疗后，有所好转。1个月内多次症状发作，再次入院后行脑MRI平扫及增强结果显示，左侧额颞部颅板下异常强化影，考虑来源硬脑膜恶性病变可能性大，恶性脑膜瘤?淋巴瘤?患者家属要求转上级医院进一步治疗，于上级医院行颅内占位性病变切除术，病理学检查诊断为B淋巴母细胞淋巴瘤。确诊为颅内B淋巴母细胞淋巴瘤，误诊时间1个月。手术治疗后好转出院。结论 颅内的B淋巴母细胞淋巴瘤属于原发性中枢神经系统淋巴瘤（PCNSL），是一种罕见的结外淋巴瘤。PCNSL可能在放射学上被误诊，其与多种疾病具有相似的影像学特征，包括脑膜瘤、硬膜下或硬膜外血肿。临床接诊此类患者时，若初诊疾病治疗效果不佳，应考虑到颅内B淋巴母细胞淋巴瘤，尽早行病理学检查。
Abstract：Objective To explore the clinical features, causes of misdiagnosis and preventive measures of intracranial B lymphoblastic lymphoma. Methods The clinical data of a patient with intracranial B lymphoblastic lymphoma who was misdiagnosed in November 2022 were retrospectively analyzed. Results The patient presented with sudden speech difficulties. After cranial CT examination, it was misdiagnosed as subdural hematoma. After corresponding treatment, there was some improvement. Symptoms occurred multiple times within one month. After re-admission, a plain and enhanced brain MRI scan was performed, which showed an abnormal enhanced shadow under the left frontal and temporal cranial plates. The possibility of a malignant lesion of the dura mater was considered: a malignant meningioma or lymphoma? The patient's family requested a transfer to a higher-level hospital for further treatment. A resection of the intracranial space-occupying lesion was performed at the higher-level hospital, and the pathological examination confirmed it as B lymphoblastic lymphoma. The misdiagnosis lasted one month. After surgical treatment, the patient improved and was discharged. Conclusion Intracranial B lymphoblastic lymphoma belongs to primary central nervous system lymphoma(PCNSL), which is a rare extranodal lymphoma. PCNSL may be misdiagnosed in radiology and has similar imaging features to many diseases, including meningiomas, subdural or epidural hematomas. When receiving such patients in clinical practice, if the initial therapeutic effect of the disease is not favorable, intracranial B lymphoblastic lymphoma should be considered and pathological examination should be performed as soon as possible.
[1] DANDACHI D, OSTROM QT, CHONG I, et al. Primary central nervous system lymphoma in patients with and without HIV infection:a multicenter study and comparison with U.S national data[J].Cancer Causes Control, 2019,30(5):477-488.
[2]杨柳.18F-FDG PET/CT在原发性中枢神经系统淋巴瘤诊断中的应用价值[D].郑州:郑州大学,2019.
[3] BARANISKIN A, CHOMIAK M, AHLE G, et al. MicroRNA-30c as a novel diagnostic biomarker for primary and secondary B-cell lymphoma of the CNS[J].J Neurooncol, 2018,137(3):463-468.
[4] GROMMES C. Central nervous system lymphomas[J].Continuum(Minneap Minn), 2020,26(6):1476-1494.
[5] GROMMES C, RUBENSTEIN J L, DEANGELIS L M, et al.Comprehensive approach to diagnosis and treatment of newly diagnosed primary CNS lymphoma[J].Neuro Oncol, 2019,21(3):296-305.
[6] SCHAFF L R, GROMMES C. Primary central nervous system lymphoma[J].Blood, 2022,140(9):971-979.
[7] THIBODEAU R, LI H K, BABU H, et al. Dural lymphoma misdiagnosed as subdural hematoma following head trauma after an episode of syncope[J].Radiology Case Reports,2022,17(12):4774-4779.
[8]周沙,曾韫璟,刘红云,等.新药在原发中枢神经系统淋巴瘤诱导和维持治疗的诊疗体会[J].临床血液学杂志,2022,35(9):680-684.
[9] LYNDON D, LANSLEY J A, EVANSON J, et al. Dural masses:meningiomas and their mimics[J].Insights Imaging, 2019,10(1):11.
[10] YAGISAWA T, IBAYASHI K, KURODA R, et al. De novo primary malignant lymphoma of the dura following recurrent episodes of subdural abscess presenting as chronic subdural hematoma:illustrative case[J].J Neurosurg Case Lessons, 2024, 8(4):CASE24153.
[11] LAPOINTE S, PERRY A, BUTOWSKI N A. Primary brain tumours in adults[J].Lancet, 2018,392(10145):432-446.
[12] GOLDBRUNNER R, STAVRINOU P, JENKINSON M D,et al. EANO guideline on the diagnosis and management of meningiomas[J].Neuro Oncol, 2021,23(11):1821-1834.
[13] AMANO T, NAKAMIZO A, MURATA H, et al. Preoperative prediction of intracranial meningioma grade using conventional CT and MRI[J].Cureus, 2022,14(1):e21610.
[14]陈智慧,陈任政,司徒敏婷,等.脑膜瘤影像分析及鉴别诊断[J].中国CT和MRI杂志,2020,18(2):54-56.
[15] MICHAUD L, BANTILAN K, MAUGUEN A, et al. Prognostic value of 18F-FDG PET/CT in diffuse large B-cell lymphoma treated with a risk-adapted immunochemotherapy regimen[J].J Nucl Med, 2023,64(4):536-541.
[16] BARAJAS R F, POLITI L S, ANZALONE N, et al. Consensus recommendations for MRI and PET imaging of primary central nervous system lymphoma:guideline statement from the International Primary CNS Lymphoma Collaborative Group(IPCG)[J].Neuro Oncol, 2021,23(7):1056-1071.
[17]李盼盼,张卓.原发性中枢神经系统淋巴瘤的治疗进展[J].大连医科大学学报,2021,43(5):456-462.
[18] WU Y W, ZHENG J, LIU L L, et al. Imaging of hemorrhagic primary central nervous system lymphoma:a case report[J].World J Clin Cases, 2020,8(15):3329-3333.
[19] Karschnia P, Batchelor T T, Jordan J T, et al. Primary dural lymphomas:clinical presentation, management, and outcome[J].Cancer, 2020,126(12):2811-2820.
[20] LEE S W, JUNG T Y, BAEK H J, et al. Dural-based primary central nervous system lymphoma with bone invasion[J].World Neurosurg, 2020,139:415-418.
[21]张斌,林晓强,景梦园,等.儿童头皮巨大B淋巴母细胞淋巴瘤1例[J].磁共振成像,2021,12(4):78-79.
[22]李欣,张鑫,张冰.不典型原发性中枢神经系统淋巴瘤1例[J].实用放射学杂志,2021,37(7):1217-1218.
[23]罗国栋,孙新海,翟宁,等.原发性中枢神经系统淋巴瘤MRI表现分析[J].医学影像学杂志,2020,30(3):354-357.
[24]何京美,黄德晖,吴卫平.原发性中枢神经系统淋巴瘤的临床特点和影像特征分析[J].解放军医学院学报,2021,42(3):291-296.
[25]潘桂海,陈韵,周飞,等.扩散加权成像及动态对比增强磁共振成像在腮腺混合瘤与腺淋巴瘤鉴别中的应用[J].实用放射学杂志,2020,36(7):1035-1038.
[26] CHENG G, ZHANG J. Imaging features(CT, MRI, MRS,and PET/CT)of primary central nervous system lymphoma in immunocompetent patients[J].Neurol Sci, 2019,40(3):535-542.
基本信息:
DOI：
中图分类号:R739.41
引用信息:
[1]张鹏,王志强,刘辉等.误诊为硬膜下血肿的颅内B淋巴母细胞淋巴瘤临床剖析[J].临床误诊误治,2025,38(13):11-15.
基金信息:
河北省医学适用技术跟踪项目（GZ2023074）