31例原发性中枢神经系统恶性淋巴瘤临床分析

Clinical Analysis of 31 Cases of Primary Central Nervous System Lymphoma

目的:分析免疫正常的原发性中枢神经系统恶性淋巴瘤患者的临床表现、影像学特点和病理表现并探讨其诊断、治疗方法。方法:回顾分析1995年7月至2006年6月经病理证实的31例原发中枢神经系统恶性淋巴瘤病例的临床、实验室检查、影像学、病理结果及治疗效果。18例采用手术+放疗+化疗方法,5例单纯手术治疗。其中化疗CHOP方案11例,替尼泊苷(VM26)+司莫司汀(me-CCNU)7例。结果:原发性中枢神经系统恶性淋巴瘤临床表现复杂,无特异性,主要为颅内压增高和神经功能缺损为主,误诊率高。脑脊液检查无阳性结果。31例均为B细胞淋巴瘤。31例中获随访24例,随访时间6～98个月,其中手术+放疗+化疗组中位生存期20个月,单纯手术组中位生存期10个月。结论:原发性中枢神经系统恶性淋巴瘤缺乏特异性临床表现,术前难以确诊,预后不良。病理检查是确诊的唯一方法。应采取综合治疗。手术的主要目的是解除肿瘤引起的颅内高压,单纯手术后,短时间内复发,应该采取手术、放疗、化疗综合治疗,这是延长生存期和改善生存质量的关键。

Objective： To analyze the elinical manifestations, imaging features, anti pathological characteristics of primary central nervous system lymphoma （PCNSL） and to explore the methods of diagnosis and treatmenh Methods： The clinical, laboratory, imaging and pathological data from 31 cases with PCNSI, seen in our hospital between July 1995 and June 2006 were retrospectively analyzed. Of the 31 cases, 18 received chemotherapy and radiotherapy after surgery, and 5 cases were treated with surgel7 alone. Results： PCNSL often appeared with nonspecific symptoms, such as elevated intracranial pressure and nerve dysfunction, leading to a relatively high misdiagnosis rate. All patients＇ CSF cellular examination was negative. All of the 31 （rases were B-cell lymphoma. Twenty-four of the 31 cases were tbllowcd up for 6-98 months. The mean survival was 20 months in the group that received surgery combined with chemotherapy and radiotherapy and 10 months in the group that underwent surgery alone. Conelusion： PCNSL has no specific clinical manifestations, thus it is difficuh to diagnose. The pathological examination ,night be the only reliable method to confirm PCNSI,. The main objective of surgical therapy is to lower the intracranial pressure. Recurrence may occur after surgery alone, so a eombined therapy with additional radiotherapy and chemotherapy is needed to prolong patients＇ survival period.