28例原发性中枢神经系统淋巴瘤临床特征分析

The clinical analysis of 28 cases of primary central nervous system lymphoma

目的 分析原发性中枢神经系统淋巴瘤（PCNSL）的临床特点,提高对PCNSL的诊治水平。方法 收集我院经病理及免疫组化确诊的PCNSL患者28例,回顾性分析患者临床诊治过程中的变化及特点。结果 28例中,经立体定向穿刺活检确诊5例,经开颅手术活检确诊7例,其余16例均经开颅单个病灶全切除或次全切除后病理确诊。确诊后,单纯化疗9例,生存期为13-43（25.22±9.35）个月;化疗＋放疗14例,生存期为10-62（31.14±14.48）个月。结论 PCNSL临床特点多变,临床表现缺乏特异性,病理确诊前诊断困难。临床表现结合特异性颅脑MRI影像可提示淋巴瘤。手术目的主要是减压并获得病理。肿瘤总体预后较差,确诊后放化疗是主要治疗手段。

Objective To analyze the clinical characteristics of primary central nervous system lymphoma（ PCNSL） and improve the diagnosis and treatment of PCNSL. Methods Clinical data of twenty- eight cases of PCNSL patients confirmed by pathological and immunohistochemical analysis were collected. The changes and characteristics of the clinical diagnosis and treatment were retrospectively analyzed. Results Among the 28 cases,5 cases were confirmed by stereotactic biopsy,7 cases were diagnosed by craniotomy,and 16 other cases were confirmed by the total or subtotal resection of single lesion. 9 cases were treated with chemotherapy. Their average survival time ranged from 13 to 43（ 25. 22 ± 9. 35） months. 14 cases were treated with chemotherapy plus radiotherapy. Their average survival time diverted 10 to 62（ 31. 14 ± 14. 48） months. Conclusion Clinical characteristics and manifestations of PCNSL were lacking in specificity. It was difficult to make diagnosis before pathology examination. The clinical manifestation and with some specific brain MRI imaging may suggest lymphoma. The purpose of surgery was to reduce the cranial pressure and achieve the pathological results. The prognosis of PCNSL was usually poor and chemotherapy plus radiotherapy was the main treatment.