著者

森内 秀祐

出版者

近畿脳腫瘍病理検討会

雑誌

Neuro-Oncologyの進歩 (ISSN:18800742)

巻号頁・発行日

vol.18, no.1, pp.1-6, 2009-11-01 (Released:2014-04-22)

参考文献数

8

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We experienced 7 cases of immunosuppressed patients with enhancing intracerebral lesions on CT and MRI at our hospital in the period between 2004 and 2008. The cases included 6 patients infected with HIV and 1 rheumatoid arthritis patient. Patients aged between 40 and 56, and they consisted of 6 males and 1 female. HIV patients are generally first treated for HIV associated benign diseases or infectious diseases, including Cryptococcus infections, fungal infections, and so on. When these treatments are not effective, a differential diagnosis for malignant lymphoma is required before considering radiation therapy and chemotherapy. We performed open 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 an immunohistochemical study, a flow cytometric study, and a gene translication study of gamma immunoglobulin genes. 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 treatments for HIV. Despite the fact that CT and MRI image studies were similar between patients, final diagnosis differed and included malignant diseases. In conclusion, we consider it difficult to make an accurate diagnosis of CT and MRI enhancing intracerebral lesions in immunosuppressed patients, and regard it as very important to undertake open biopsies to make a final diagnosis and to differentiate between a variety of disorders in such patients.