Subacute Sensorimotor Polyneuropathy as Sole Manifestation of Occult Non Hodgkin’s Lymphoma: Infiltrative or Paraneoplastic?
Subacute Sensorimotor Polyneuropathy as Sole Manifestation of Occult Non Hodgkin’s Lymphoma: Infiltrative or Paraneoplastic?
复制标题
亚急性感觉运动性多发性神经病是隐匿性非霍奇金淋巴瘤的唯一表现：浸润性还是副肿瘤性？
DOI：
10.1007/s12288-010-0043-1
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发表时间：
2010
影响因子：
0.9
通讯作者：
S. Mahajan
中科院分区：
文献类型：
--
作者：
S. Acharya;S. Shukla;S. Mahajan
讨论淋巴瘤有时会影响周围神经系统。5%的淋巴瘤患者会出现周围神经系统异常[2]。诊断可能是难以捉摸的，因为许多患者没有已知的淋巴瘤，就像本例。大多数周围神经并发症是由非霍奇金淋巴瘤引起的，它渗透到神经导致轴突损伤。虽然神经活检可以更好地揭示我们病例的病理过程，但神经病变的脱髓鞘性质可能排除了浸润性病变。可累及非霍奇金淋巴瘤的结构是神经根和脑神经，通常与淋巴瘤脑膜炎有关。非霍奇金淋巴瘤也可渗入周围神经，引起神经丛病变、单神经病变或全身性神经病变。这些神经病可能类似于多发性非对称性单神经病或全身性疾病，如慢性炎症性脱髓鞘多神经根神经病(CIDP)。当非霍奇金淋巴瘤弥漫性渗入时，使用术语神经淋巴瘤病。相比之下，霍奇金淋巴瘤(HL)很少侵犯神经，相反，它会导致周围神经系统的免疫紊乱，如炎症性丛丛病或格林-巴利综合征。其他罕见的淋巴瘤，如血管内淋巴瘤和Waldenstrom‘s巨球蛋白血症，也会以特定的方式影响周围神经。此外，其他恶性和非恶性淋巴增生性疾病可作为淋巴瘤性神经病的鉴别诊断[3]。
DiscussionLymphoma occasionally affects the peripheral nervous system. Peripheral nervous system abnormalities occur in 5% of patients with lymphoma [2]. The diagnosis can be elusive since many patients present without known lymphoma as in this case. Most peripheral nerve complications are due to NHL, which infiltrates nerves causing axonal damage. Though nerve biopsy could have thrown more light about the pathologic process in our case, the demyelinating nature of the neuropathy probably rules out infiltration. The structures that can be involved in NHL are nerve roots and cranial nerves, often associated with lymphomatous meningitis. NHL may also infiltrate peripheral nerves and cause plexopathy, mononeuropathy, or generalized neuropathy. These neuropathies may resemble an asymmetric mononeuropathy multiplex or a generalized disorder such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). When NHL infiltrates diffusely, the term neurolymphomatosis is used. Hodgkin’s lymphoma (HL), by contrast, rarely infiltrates nerves, rather HL causes immunological disorders of the peripheral nervous system such as inflammatory plexopathy or Guillain-Barré syndrome. Other rare lymphomas such as intravascular lymphoma and Waldenstrom’s macroglobulinemia can also affect peripheral nerves in specific ways. In addition, other malignant and nonmalignant lymphoproliferative disorders enter into the differential diagnosis of lymphomatous neuropathy [3].