原发性脊柱硬膜外淋巴瘤的诊治

Clinical research on primary spinal epidural lymphomas

目的探讨原发性脊柱硬膜外淋巴瘤的临床特点及其早期诊治。方法对11例经病理证实为原发性脊柱硬膜外淋巴瘤患者的临床特点、诊断治疗及随访结果进行分析和总结。结果11例患者中，男性8例，女性3例，年龄43—69岁，平均49岁，所有患者均有神经受压的症状、体征，病史4周到1年，平均4个月，所有患者骨髓活检结果和脊柱X线平片呈阴性，核磁共振成像均可发现椎体信号改变，9例患者见椎管内软组织影。3例患者椎体穿刺活检证实淋巴瘤，8例患者呈阴性结果，后通过手术确诊。所有患者均于穿刺或手术确诊后给予化疗。随访时间半年到10年，1例于治疗后半年死亡，生存期最长者10年。结论原发性脊柱硬膜外淋巴瘤临床表现不典型，极易误诊，对于影像学阳性而穿刺活检为阴性的患者应高度怀疑本病，多数患者通过化疗可取得较好的临床效果。

Objective To analyze the clinical manifestation and management of patients with primary spinal epidural lymphomas. Methods Eleven cases of patients who were pathologically confirmed primary spinal epidural lymphomas were retrospectively analyzed. Results All the 11 patients（ 8 men, 3 women, aged 43 - 69, mean age 49 years） got the symptom and objective sign of the spinal cord compression. The course of disease ranged from 4 weeks to 1 year（ average 4 months）. The results of bone marrow biopsy and X-ray were all negative. Signal change was found in magnetic resonance imaging（ MRI）, and intraspinal parenchyma shadow was found in 9 cases. Three cases were pathologically confirmed of lymphomas by puncturation biopsy. Eight cases which were negative for puncturation biopsy were confirmed lymphomas through operation. All the pa- tients were treated with chemotherapy after pathologically confirmed by puncturation or operation. The follow up time was from 6 months to 10 years. One case was dead 6 months after therapy. The longest duration was 10 years. Conclusion Primary spinal epidural lymphomas was easily to be misdiagnosed in early stage, and the patients who have positive iconography and negative puncturation biopsy results should be paid more attention to. Most patients were sensitive to chemotherapy and the prognosis was relatively good.