硬脑膜浆细胞瘤 (Dural Plasmacytoma )MRI病例图片影像诊断分析

脑脊膜   2010-10-22

 【临床病史】:74岁女性,头痛。74-year-old female with history of headache.

【影像图片】MRI图像


 


 

 【影像改变】:There is an extra-axial, dural based mass predominantly in the high left posterior parietal region which is relatively isointense signal on TI (yellow arrow in Figure 1) and T2 (yellow arrow in Figure 2) sequences. 图示左侧后顶部的以脑膜为基底的脑外肿块,在T1和T2序列上呈相对的等信号。

    The lesion demonstrates homogeneous contrast enhacement on post contrast sequences, (yellow arrow in Figure 3). Extension along the interhemispheric fissure (yellow arrow in Figure 4), encasement of the superior sagittal sinus (red arrow inFigure 4) and extension across midline to the right (blue arrow in Figure 4) is demonstrated.

    病变显示明显的强化(图3、黄箭),病变沿大脑纵裂扩展(图4、黄箭),包埋上矢状窦(图4、红箭)和沿中线扩展至右侧(图4、蓝箭)

 【影像诊断】:硬膜浆细胞瘤 Dural Plasmacytoma

【讨论】:Plasmacytomas of the dura are uncommon plasma cell tumors that may occur as a solitary neoplasm or, more commonly, in association with multiple myeloma. The latter is usually accompanied by multiple lytic lesions of the skull. In distinction, solitary craniocerebral plasmacytomas are relatively benign and potentially curable. Therefore, distinction between the two has important clinical consequences. The differential diagnosis for dural plasmacytoma includes metastasis, lymphoma, dural sarcoma, plasma cell granuloma and meningioma.

    孤立性的硬膜浆细胞瘤是不常见的,而多发性骨髓瘤相关的浆细胞瘤相对更常见些。后者通常伴有颅骨多发性囊性病变。区别是,孤立性的颅脑浆细胞瘤是相对良性并有潜在的可治愈性。因此,两者的鉴别有重要的临床意义。硬膜浆细胞瘤的鉴别诊断包括转移瘤,淋巴瘤、硬脑膜肉瘤、浆细胞瘤肉芽肿和脑膜瘤。

    Dural plasmacytomas are often confused with meningiomas (the most common extra-axial neoplasm found in adults) as the two have similar features and imaging characteristics. Both occur more commonly in women during the 5th decade of life with a predilection for similar sites of involvement including the cerebral convexities, sphenoid ridge, falx, and tentorium. On MR both may appear nearly isointense to brain on T1W images and iso- to hyperintense on T2W images with marked contrast enhancement. A characteristic "dural tail" and intratumoral calcifications may be seen in both lesions. Other manifestations of intracranial plasmacytoma may include diffuse leptomeningeal disease and rarely, intracerebral lesions with vasogenic edema.

    硬膜浆细胞瘤常常跟脑膜瘤(是成人最常见的脑外肿瘤)相混淆,因为两者具有类似的临床及影像特征。两者都常见于50岁左右的女性,累及部位也类似,包括大脑凸面、蝶骨脊、大脑镰和小脑幕。在MRT1序列上两者都与脑实质信号相接近,在T2序列上表现为等到高信号,有明显的强化。特征性的脑膜尾征和软脑膜钙化也都可以见于两者。颅内浆细胞瘤的其他表现包括弥漫性的脑膜病变和少见的颅内血管源性水肿。
 
    These patients may present with intracranial hypertension and/or focal neurological signs from the dural origin of the tumor. Clinically, individuals with solitary dural plasmacytomas can be distinguished from those with multiple myeloma by the absence of hypercalcemia, renal insufficiency, anemia, lytic osseoues lesions, bone marrow plasmacytosis, and elevated serum or urinary paraprotein. Following surgical decompression and/or local radiotherapy for a solitary dural plasmacytoma, the prognosis is fairly good. This is in contrast to patients with plasmacytoma and multiple myeloma who typically have a much poorer prognosis.

    这些病变可以表现为颅高压和/或局部神经定位体征,临床上,可以通过是否有高血钙、肾功能不全、贫血、多发性囊性骨病变、骨髓浆细胞增多以及血浆或尿液副蛋白增高等特征来鉴别究竟是孤立性浆细胞瘤,还是多发性骨髓瘤相关的浆细胞瘤。通过外科减压术和/或局部的放疗,孤立性浆细胞瘤预后可以相对良好,而多发性骨髓瘤的预后通常更糟糕。

(参考来源:,ACR Thursday, December 3, 2009,作者:freemanpyw)
评论
    loading...