原发性中枢神经系统淋巴瘤16例临床分析及文献回顾

Sixteen cases with primary central nervous system lymphoma:clinical analysis with literature review

目的探讨原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)的临床特点及诊治措施。方法总结我院1993年7月至2005年9月收治的16例免疫正常的PCNSL患者的临床资料。结果16例PCNSL,男11例,女5例,中位年龄52岁。就诊时主要临床表现为颅内压增高、偏瘫和癫痫,肿瘤多位于幕上的额顶颞叶。11例行手术,4例行立体定向活检,均给予放化疗,2000年1月以前的10例患者行VM-26+BCNU化疗,2000年1月以后的6例患者均给予大剂量甲氨蝶呤化疗。2000年以前的10例患者已全部死于肿瘤复发,中位生存期为16个月。2000年以后的6例患者已有3例死亡,中为生存期为29个月。结论原发性中枢神经系统淋巴瘤是一种恶性肿瘤,无特殊临床表现和影像学特征。颅内压增高为主要表现,大剂量甲氨蝶呤化疗联合放疗治疗PCNSL有效。

Objective We reported 16 cases of immunocompetent patients with primary central nervous system lymphoma （PCNSL） and analyzed its clinical characteristics, diagnosis and treatment. Methods Sixteen cases of immunocompetent patients with PCNSL admitted during 1993.7 to 2005.9 were included, Results There were 11 male and 5 female with median age of 52 years old. Symptoms included increase intracranial pressure, hemiparalysis and epilepsy. Most tumors were located at the frontal and temporoparietal regions. Eleven cases were operated, and 4 cases received stereotactic biopsy. All cases underwent radiotherapy and chemotherapy. Before 2000, 10 cases who received VM-26＋BC-NU chemotherapy plus WBRT died. Their median survival time was 16 months. After 2000, 3 in 6 cases who received high-dose MTX chemotherapy plus WBRT died. Their median survival time was 29 months. Conclusions The clinical features and neuroimaging findings are nonspecific. Intracranial hypertension is the main clinical manifestation. High-dose MTX chemotherapy plus WBRT is effective for PCNSL.