免疫不全患者の脳内造影病変で悪性リンパ腫と鑑別すべき疾患
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We experienced 7 cases of immunosuppressed patients with enhancing intracerebral lesions on CT and MRIat our hospital in the period between 2004 and 2008. The cases included 6 patients infected with HIV and 1rheumatoid arthritis patient. Patients aged between 40 and 56, and they consisted of 6 males and 1 female. HIVpatients are generally first treated for HIV associated benign diseases or infectious diseases, including Cryptococcusinfections, fungal infections, and so on. When these treatments are not effective, a differential diagnosisfor malignant lymphoma is required before considering radiation therapy and chemotherapy. We performedopen biopsies on all cases, and used a computer aided navigation system to assist in our minimal invasive surgery.The average total volume of specimens attained by biopsy was about 1cm3 and enough to undertake animmunohistochemical study, a flow cytometric study, and a gene translication study of gamma immunoglobulingenes. The final diagnosis of the 7 cases were diffuse large B cell lymphoma, adult T cell lymphoma, toxoplasmosis,a lymphoproliferative state due to an EB virus infection, and immuno-reconstruction syndrome after treatmentsfor HIV. Despite the fact that CT and MRI image studies were similar between patients, final diagnosisdiffered and included malignant diseases. In conclusion, we consider it difficult to make an accurate diagnosisof CT and MRI enhancing intracerebral lesions in immunosuppressed patients, and regard it as very importantto undertake open biopsies to make a final diagnosis and to differentiate between a variety of disorders in suchpatients.
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