糖皮质激素影响原发性中枢神经系统淋巴瘤诊断一例报告并文献复习

Effects of glucocorticoid on primary central nervous system lymphoma:a case report and literature review

目的探讨糖皮质激素在原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)确诊前后及治疗中的作用。方法选取2019年3月12日首都医科大学附属北京天坛医院收治的1例免疫功能正常、两次活检后确诊的PCNSL患者,回顾分析其诊治过程。结果本例患者以"头痛伴视物不清"起病,首次立体定向活检术后病理未见肿瘤细胞,经验性激素冲击治疗后1个月余复查头部MRI病灶明显缩小,约2个月后复查头颅MRI发现病灶较前增大,经第2次穿刺活检后明确诊断为PCNSL。确诊后予利妥昔单抗联合大剂量氨甲蝶呤、地塞米松方案治疗6个周期后,头痛、记忆力减退、视物模糊等症状明显好转,KPS评分80分,复查头颅MRI根据RANO标准疗效评价达到完全缓解。结论糖皮质激素在PCNSL患者确诊前的试验性用药及确诊后的常规治疗中均有重要作用,加强对PCNSL诊疗过程中糖皮质激素作用的认识有利于PCNSL的早期诊断及治疗。

Objective To explore the role of glucocorticoid in primary central nervous system lymphoma(PCNSL)diagnosis and treatment.Methods The diagnosis and treatment process of an immunocompetent patient who was diagnosed as PCNSL by biopsies until the second time were retrospectively reviewed.Results The patient was a 39-years-old woman who was hospitalized for intracranial space-occupying lesion,and the first stereotactic CT-guided biopsy suggested inflammation but no signs of PCNSL.Through glucocorticoid therapy,the lesion shown in medical imaging reduced,but it recurred after one month.And the diagnosis of PCNSL was then confirmed by a second-time biopsy.Complete remission was induced through standardized treatment.Conclusions It is necessary for clinicians,especially Neuro-oncologist to further the understanding of PCNSL and role of glucocorticoid in PCNSL to improveits early diagnosis and treatment.