原发性中枢神经系统淋巴瘤的诊治

The diagnosis and treatment in primary central nervous system lymphama （PCNSL）

目的探讨原发性中枢神经系统细胞瘤的临床诊断和治疗。方法回顾性分析我院2001年12月至2005年5月间经立体定向活检或手术病理证实的12例原发性中枢神经系统细胞瘤临床表现特点及治疗结果。结果12例病人中手术切除7例，立体定向活检5例。本组12例共21个肿瘤，其中7例（58．3％）为多发性肿瘤，肿瘤多位于额部、颞顶部及基底节区，11例（91．7％）病人肿瘤主体均位于小脑幕上。组织病理学检查发现12例病人均为B细胞来源。4例病人辅以放疗，8例病人辅以放疗和化疗，生存时间为4—37个月，中位生存时间为16．3个月。结论原发性中枢神经系统细胞瘤术前诊断困难，预后差，诊断主要靠病理。该疾病多采用综合治疗，术后辅以放、化疗。近年的大剂量甲氨蝶呤化疗受到关注。

Objective The purpose of our study is to explore the diagnosis and treatment in primary central nervous system lymphama. Method Twelve cases of PCNSL patients which had been defined by biopsy or surgical pathology from december 2001 to may 2005 were analyzed retrospectively. Results Seven patients were treated with surgical resection but five patients only biopsy. A total of 21 tumors were seen in 12 patients ： the most commom sites were frontal, temporoparietal, and basal ganglia; multiple lesions were seen in 7 patients. In 11 of these patients,the main bulk of the tumors were in a supratentofial location. All of patients were B-cell lymphomas. The mediam follow-up was 16.3 months, ranging from 4-37 months. Conclusions PCNSL is an aggressive lymPhoma,which shows cytological variability from case to case . Accurate diagnosis before operation is difficult and the prognosis is poor. Chemotherapy combined with radiotherapy play an important role in the management of PCNSL. We need further clinical study to determine the most optimal treatment modality.