1、mr diagnosis of dural plasmacytomas 硬腦膜漿細胞瘤mr診斷 dural plasmacytomas are uncommon extramedullary plasma cell tumors that should be considered in patients with a dural mass and history of plasma cell dyscrasia. 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病史，出現硬膜腫塊時需要考慮到本病的可能。overview only see a small number of r

2、eported literature國內外文獻僅見少數報道 and proposed the following diagnostic criteria并提出如下診斷標準no other bone involvement in x-rayx線無其它骨受累must be confirmed histologically必須有組織學證實 bone marrow biopsy negative骨髓穿刺陰性 not proteinuria, hyperlipidemia無高蛋白血癥和本周蛋白尿74-year-old female with history of headache. 74歲女性，頭痛。c

3、aseisointense signal on ti relatively在t1序列上呈相對的等信號isointense signal on t2 relatively在t2序列上呈相對的等信號增強t1wi橫軸位the lesion demonstrates homogeneous contrast enhacement 增強t1wi冠狀位the lesion demonstrates homogeneous contrast enhacement in coronalthere is an extra-axial, dural based mass predominantly in the

4、high left posterior parietal region which is relatively isointense signal on ti and t2 sequences. 圖示左側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。 12the lesion demonstrates homogeneous contrast enhacement on post contrast sequences, (yellow arrow in figure 3). extension along the interhemispheric fissure (yell

5、ow 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（圖4、藍箭） 34 differentiation between the solitary form and plasmacytoma in

6、association with multiple myeloma has important treatment implications. 區別是孤立性漿細胞瘤還是多發性骨髓瘤相關的漿細胞瘤對于治療有重要的意義。 emphasis imaging characteristics of dural plasmacytomas may closely resemble those of meningiomas.硬膜漿細胞瘤的影像特征與腦膜瘤非常相似。 plasmacytomas of the dural are uncommon plasma cell tumors that may occu

7、r as a solitary neoplasm more commonly, in association with multiple myeloma. 孤立性的硬膜漿細胞瘤是不常見的，而多發性骨髓瘤相關的漿細胞瘤相對更常見些。 the latter is usually accompanied by multiple lytic lesions of the skull.后者通常伴有顱骨多發性囊性病變。 in distinction, solitary craniocerebral plasmacytomas are relatively benign and potentially cu

8、rable. 區別是，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, distinction between the two has important clinical consequences.因此，兩者的鑒別有重要的臨床意義。 the differential diagnosis for dural plasmacytoma includes metastasis, lymphoma, dural sarcoma, plasma cell granuloma and meningioma. 硬膜漿細胞瘤的鑒別診斷包括轉移瘤，淋巴瘤、硬腦膜肉瘤、漿細胞瘤肉芽腫和腦

9、膜瘤。differential diagnosis first, to exclude myeloma and other parts of the plasma cell sarcoma involving the intracranial首先要排除骨髓瘤和其他部位的漿細胞肉瘤累及顱內 because they are completely different treatment and prognosis因為它們的治療及預后完全不同 learn more about the history through which bone or other parts of the primary t

10、umor can be identified通過詳細了解病史，后者有骨或其他部位的原發灶可鑒別 and is the difference between plasma cell granuloma, which is fully mature plasma cells, and mixed more lymphocytes and plasma cells and other inflammatory cells. 與漿細胞肉芽腫的區別是，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 dural plasmacytomas are often confused w

11、ith meningiomas (the most common extra-axial neoplasm found in adults) as the two have similar features and imaging characteristics.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。 both occur more commonly in women during the fifty year old with a predilection for similar sites of involvement includin

12、g the cerebral convexities, sphenoid ridge, falx and tentorium.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。 on mr both may appear nearly isointense to brain on t1w images and iso- to hyperintense on t2w images with marked contrast enhancement.在mrt1序列上兩者都與腦實質信號相接近，在t2序列上表現為等到高信號，有明顯的強化。 a characteristi

13、c dural tail and intratumoral calcifications may be seen in both lesions.特征性的腦膜尾征和軟腦膜鈣化也都可以見于兩者。 second, with the rich in lymphocytes - plasma cells in the meningioma difference between the first image of their organization have meningioma components were mixed lymphocytes and plasma cells infiltrat

14、ion, and the disease lack the basic image of meningioma, and a single mature plasma cells. 與富于淋巴細胞-漿細胞的腦膜瘤區別，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。 other manifestations of intracranial plasmacytoma may include diffuse leptomeningeal disease and rarely, intracerebral lesions with v

15、asogenic edema.腦膜漿細胞瘤的表現包括彌漫性的腦膜病變和少見的顱內血管源性水腫。 these patients may present with intracranial hypertension and/or focal neurological signs from the dural origin of the tumor.這些病變可以表現為顱高壓和/或局部神經定位體征。 clinical manifestations clinically, individuals with solitary dural plasmacytomas can be distinguished

16、 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.臨床上，可以通過是否有高血鈣、腎功能不全、貧血、多發性囊性骨病變、骨髓漿細胞增多以及血漿或尿液副蛋白增高等特征來鑒別究竟是孤立性漿細胞瘤，還是多發性骨髓瘤相關的漿細胞瘤。 solitary meningeal plasmacytoma generally complete resection, prognosis than the brain parenchyma and multiple myeloma good.腦膜孤立性漿細胞瘤一般可完整切除，預后較腦實質內者和多發性骨髓瘤好。treatment following surgica