原发性中枢神经系统淋巴瘤的诊断和治疗

Diagnosis and treatment of primary central nervous system lymphoma

目的 探讨原发性中枢神经系统淋巴瘤的诊断、治疗和预后.方法 对6例经开颅、立体定向活检或神经内镜手术后病理证实的中枢神经系统淋巴瘤患者的临床资料及预后情况进行回顾性分析.结果 所有病例均为单发病变,其中病灶位于胼胝体者2例,左尾状核者1例,左额叶者1例,右小脑者1例,前颅窝底及视神经管者1例,经开颅手术切除＋地塞米松治疗者2例,经开颅手术切除＋地塞米松＋放疗者1例,经开颅手术＋甲强龙＋甲氨蝶呤治疗者1例,经立体定向活检者＋甲强龙＋甲氨蝶呤治疗者1例,经神经内镜手术＋甲强龙＋甲氨蝶呤治疗者1例,随访3～25个月,病灶完全消失者5例,病灶显著缩小者1例,随访期间无死亡病例.结论 原发性中枢神经系统淋巴瘤的诊断建议以立体定向活检取病理为主,推荐激素＋化疗＋放疗等为主的综合治疗.

Objective To explore the diagnosis, treatment and prognosis of primary central nervous system lymphoma. Methods A retrospective analysis of the clinical data and surgical results was performed in 6 cases that were diagnosed as having primary central nervous system lymphomas. Results All cases had single lesion. Of the 6 lesions, 2 were located at corpus callosum, 1 in the left caudate nucleus, 1 in the left frontal lobe, 1 in the right cerebellum and the other one in the anterior skull base and optic nerve canal. Two cases were treated with surgical resection and dexamethasone, 1 with surgical resection and dexamethasone followed by radiology, 1 with surgical resection and metacortandralone and methopterin, 1 with metacortandralone and methopterin after stereotactic surgery for biopsy, while the other one was treated with metacortandralone and methopterin after endoscopic neurosurgery. All patients were followed by 3 to 25 months. 5 lesions were disappeared completely, while the volume of one lesion was decreased greatly. No deaths occurred in the followup period. Conclusions The stereotactic biopsy is recommended to gain samples and make diagnosis of primary central nervous system lymphoma. The patients can have a relatively long remission after combined therapies, such as hormone, chemotherapy and radiotherapy.