原发性中枢神经系统恶性淋巴瘤的诊断与治疗

Diagnosis and treatment of primary central nervous system lymphoma

目的探讨原发性中枢神经系统恶性淋巴瘤(PCNSL)的临床特征及诊疗经验。方法回顾性分析13例确诊为PCNSL患者的临床资料。结果 11例经立体定向穿刺活检,2例经手术切除病理确诊。术后均接受放疗和化疗。随访3例分别死于确诊后3月、11月、18月,2例存活已超过3年,2例已超过2年,2例已超过1年,确诊不到1年的4例生存良好。结论对影像学高度怀疑PCNSL的病人主张选择立体定向穿刺活检确诊,对有脑疝倾向或脑疝的病人仍需要开颅手术切除肿瘤。确诊后,以小剂量放疗+化疗的综合治疗疗效较好。

Objectives To explore the clinical feature, diagnosis and treatment for primary central nervous system lymphoma （PCNSL）. Methods The clinical data of 13 patients who were pathologically confirmed as PCNSL were analyzed retrospectively. Results Eleven cases were diagnosed by stereotactic biopsy, 2 by resection. Chemotherapy after radiotherapy were performed for all patients. Two patients had survived more than 3 years, 2 more than 2 years, 2 more than 1 years and 4 diagnosed no more than one year survived. Two patients died 3 months, 11 months and 18 months separately after confirmed diagnosed. Conclusions Stereotactic biopsy is recommended for patients highly suspected as PCNSL by image studying. Craniectomy is necessary for patients suffering from cerebral herniation or risk of cerebral herniation. Combined therapy with low-dose radiation followed with chemotherapy may acquire better results after confirmed diagnosis was made.