原发性中枢神经系统淋巴瘤24例临床分析

Clinical analysis of 24 cases with primary central nervous system lymphoma

目的:探讨原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)的临床特征、治疗及预后。方法:回顾性分析24例PCNSL患者的临床特征及治疗方案,并随访复发率及生存状况。结果: 24例PCNSL患者中,术前考虑为淋巴瘤的仅有6例,其余病例均为术后病理证实。术后病理结果为弥漫性大B细胞性淋巴瘤16例,中枢神经系统浆细胞瘤4例,浆细胞性骨髓瘤4例。术后20例患者进行了放化疗,2例进行了单纯化疗,2例由于经济原因再未进行任何辅助治疗。病变发生部位在大脑半球者16例,发生于小脑相应部位者4例,发生于脊髓者4例。术后病情稳定伤口拆线后,24例患者均转入血液科继续治疗。定期随访发现,其中16例生存(KPS评分为60~80 分),6例术后2个月内死亡,2例失访。结论: PCNSL 在中枢神经系统肿瘤中少见且极易误诊,多发于中老年男性,其病理结果大多数为弥漫性大B细胞性淋巴瘤。手术治疗既有利于疾病的确诊也可显著缓解患者颅内高压症状,再联合放化疗,可在一定程度上提高患者生活质量并延长生存期限。

Objective: To investigate the clinical features,treatment and prognosis of primary central nervous system lymphoma (PCNSL). Methods: Twenty-four cases with PCNSL were selected and retrospectively analyzed.And the recurrence rate and survival status of the patients were followed up. Results: Twenty-four cases with PCNSL,only 6 cases were considered as lymphoma before surgery,and the rest of cases were confirmed by postoperative pathology.The postoperative pathological results were 16 cases with diffuse large B-cell lymphoma ,4 cases with central nervous system plasmacytoma,and 4 cases with plasma cell myeloma.After surgery ,20 cases were received radiotherapy and chemotherapy,2 cases were received chemotherapy alone,and 2 cases were didn′t adjuvant therapy for economic reasons.There were 16 cases in the cerebral hemisphere,4 cases in the corresponding parts of the cerebellum ,and 4 cases in the spinal cord.After the postoperative stable wound disintegration,24 patients were transferred to the department of hematology for further treatment.After follow-up treatment,16 patients survived (KPS score 60-80),6 patients died within 2 months after surgery,and 2 patients were lost to follow-up. Conclusion: PCNSL is rare and easily misdiagnosed in central nervous system tumors,mostly in middle-aged and elderly men.The pathological results are mostly diffuse large B-cell lymphoma.Surgical treatment is beneficial to the diagnosis of the disease and can significantly alleviate the symptoms of craniocerebral hypertension.Combined with radiotherapy and chemotherapy,it can improve the quality of life and prolong the survival of patients to some extent.