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- NP (5) - Reactivated CNS toxoplasmosis
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These photos are taken from H&E sections of a resected right frontal lobe, intra-axial, focally enhancing lesion in a 56 year-old woman. What are your differential diagnoses or your final diagnosis?
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本帖最后由 于 2006-11-14 10:24:00 编辑
聞道有先後,術業有專攻
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wangliping 离线
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zhongshihua 离线
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本帖最后由 于 2007-01-22 21:32:00 编辑
这是一例教学病例，典型有趣，我翻译马老师的帖子如下：
该例是一典型的中枢神经系统弓形虫原虫感染所致的激活性感染。常见于免疫抑制患者，核磁共震检查可见脑内多灶性病变，类似多发性转移灶和淋巴瘤,影像学与CNS淋巴瘤和多发性转移灶难以区分。
关键是要在脑组织的坏死和炎性病变中认出弓形虫原虫。弓形虫原虫似乎有一个假囊，假囊中含有许多裂殖子(慢分裂)；当假囊破裂以后，它们以散在的速殖体形式出现。常见有血管周袖套状淋巴和浆细胞浸润，许多病例也有微小的胶质结节增生，石蜡切片姬姆萨染色可以较好地显示这些小的弓形虫原虫，如果没有经验的病理医生可能被坏死和炎性背景迷惑，弓形虫原虫的特异性抗原免疫染色有利于鉴别诊断。如果诊断及时，抗生素可治愈.
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This is a classic case of CNS toxoplasmosis caused by reactivated infection by protozoan Toxoplasma gondii. This reactivated infection often occurs in immunosuppressed patients. On MRI images, CNS toxoplasmosis is often multifocal and may be difficult to distinguish from CNA lymphoma and multiple metastases. Identification of the protozoan micro-organisms in necrotic and inflammatory brain parenchyma is the key to accurate diagnosis. They may appear as pseudocysts containing many bradyzoites (slowly dividing) or scattered tachyzoites (rapidly dividing) that have escaped from ruptured pseudocysts. Perivascular cuffing by lymphoplasmacytic cells is always present, whereas microglial nodules are seen in a majority of cases. Giemsa stain of paraffin sections can highlight these small organisms, but the background of necrosis and inflammation usually make their detection difficult in inexperienced eyes. Immunohistochemical stain for Toxoplasma gondii-specific antigens is available. If diagnosed in time, anmicrobial treatment may resolve the disease.
聞道有先後,術業有專攻
