MRdiagnosisofDuralPlasmacytomas

硬腦膜漿細胞瘤MR診斷Duralplasmacytomasareuncommonextramedullaryplasmacelltumorsthatshouldbeconsideredinpatientswithaduralmassandhistoryofplasmacelldyscrasia.

硬腦膜漿細胞瘤是一種不常見的髓外漿細胞腫瘤，當病人有漿細胞性惡液質(zhì)病史，出現(xiàn)硬膜腫塊時需要考慮到本病的可能。OverviewOnlyseeasmallnumberofreportedliterature國內(nèi)外文獻僅見少數(shù)報道Andproposedthefollowingdiagnosticcriteria并提出如下診斷標準①nootherboneinvolvementinx-rayX線無其它骨受累②Mustbeconfirmedhistologically必須有組織學證實③Bonemarrowbiopsynegative骨髓穿刺陰性④NotProteinuria,hyperlipidemia無高蛋白血癥和本周蛋白尿isointensesignalonTIrelatively在T1序列上呈相對的等信號isointensesignalonT2relatively在T2序列上呈相對的等信號增強T1WI橫軸位Thelesiondemonstrateshomogeneouscontrastenhacement

Thereisanextra-axial,duralbasedmasspredominantlyinthehighleftposteriorparietalregionwhichisrelativelyisointensesignalonTIandT2sequences.圖示左側(cè)后頂部的以腦膜為基底的腦外腫塊，在T1和T2序列上呈相對的等信號。12Thelesiondemonstrateshomogeneouscontrastenhacementonpostcontrastsequences,(yellowarrowinFigure3).Extensionalongtheinterhemisphericfissure(yellowarrowinFigure4),encasementofthesuperiorsagittalsinus(redarrowinFigure4)andextensionacrossmidlinetotheright(bluearrowinFigure4)isdemonstrated.病變顯示明顯的強化（圖3、黃箭），病變沿大腦縱裂擴展（圖4、黃箭），包埋上矢狀竇（圖4、紅箭）和沿中線擴展至右側(cè)（圖4、藍箭）34Differentiationbetweenthesolitaryformandplasmacytomainassociationwithmultiplemyelomahasimportanttreatmentimplications.區(qū)別是孤立性漿細胞瘤還是多發(fā)性骨髓瘤相關(guān)的漿細胞瘤對于治療有重要的意義。emphasisPlasmacytomasoftheduralareuncommonplasmacelltumorsthatmayoccurasasolitaryneoplasmmorecommonly,inassociationwithmultiplemyeloma.孤立性的硬膜漿細胞瘤是不常見的，而多發(fā)性骨髓瘤相關(guān)的漿細胞瘤相對更常見些。Thelatterisusuallyaccompaniedbymultiplelyticlesionsoftheskull.后者通常伴有顱骨多發(fā)性囊性病變。Indistinction,solitarycraniocerebralplasmacytomasarerelativelybenignandpotentiallycurable.區(qū)別是，孤立性的顱腦漿細胞瘤是相對良性并有潛在的可治愈性。Therefore,distinctionbetweenthetwohasimportantclinicalconsequences.因此，兩者的鑒別有重要的臨床意義。Thedifferentialdiagnosisforduralplasmacytomaincludesmetastasis,lymphoma,duralsarcoma,plasmacellgranulomaandmeningioma.硬膜漿細胞瘤的鑒別診斷包括轉(zhuǎn)移瘤，淋巴瘤、硬腦膜肉瘤、漿細胞瘤肉芽腫和腦膜瘤。DifferentialDiagnosisAndisthedifferencebetweenplasmacellgranuloma,whichisfullymatureplasmacells,andmixedmorelymphocytesandplasmacellsandotherinflammatorycells.

與漿細胞肉芽腫的區(qū)別是，后者的漿細胞完全成熟，并混雜較多的淋巴細胞和漿細胞，并常有其它炎細胞浸潤Duralplasmacytomasareoftenconfusedwithmeningiomas(themostcommonextra-axialneoplasmfoundinadults)asthetwohavesimilarfeaturesandimagingcharacteristics.硬膜漿細胞瘤常常跟腦膜瘤（是成人最常見的腦外腫瘤）相混淆，因為兩者具有類似的臨床及影像特征。Bothoccurmorecommonlyinwomenduringthefiftyyearoldwithapredilectionforsimilarsitesofinvolvementincludingthecerebralconvexities,sphenoidridge,falxandtentorium.兩者都常見于50歲左右的女性，累及部位也類似，包括大腦凸面、蝶骨嵴、大腦鐮和小腦幕。Acharacteristic"duraltail"andintratumoralcalcificationsmaybeseeninbothlesions.特征性的腦膜尾征和軟腦膜鈣化也都可以見于兩者。Second,withtherichinlymphocytes-plasmacellsinthemeningiomadifferencebetweenthefirstimageoftheirorganizationhavemeningiomacomponentsweremixedlymphocytesandplasmacellsinfiltration,andthediseaselackthebasicimageofmeningioma,andasinglematurePlasmacells.與富于淋巴細胞-漿細胞的腦膜瘤區(qū)別，后者其組織圖像首先有腦膜瘤成分，淋巴細胞和漿細胞呈混合浸潤，而本病缺乏腦膜瘤的基本圖像，且為單一的較成熟的漿細胞。Othermanifestationsofintracranialplasmacytomamayincludediffuseleptomeningealdiseaseandrarely,intracerebrallesionswithvasogenicedema.腦膜漿細胞瘤的表現(xiàn)包括彌漫性的腦膜病變和少見的顱內(nèi)血管源性水腫。Thesepatientsmaypresentwithintracranialhypertensionand/orfocalneurologicalsignsfromtheduraloriginofthetumor.這些病變可以表現(xiàn)為顱高壓和/或局部神經(jīng)定位體征。

ClinicalmanifestationsSolitarymeningealplasmacytomagenerallycompleteresection,prognosisthanthebrainparenchymaandmultiplemyelomagood.腦膜孤立性漿細胞瘤一般可完整切除，預(yù)后較腦實質(zhì)內(nèi)者和多發(fā)性骨髓瘤好。TreatmentFollowingsurgicaldecompressionand/orlocalradiotherapyforasolitar