非霍奇金淋巴瘤中枢神经系统侵犯5例观察及文献复习

Central nervous system involvement of non-Hodgkin's lymphoma:a report of 5 cases and literature review

目的提高对非霍奇金淋巴瘤(NHL)中枢神经系统侵犯(SCNSL)的认识。方法收集2010年6月至2018年5月共5例NHL发生SCNSL患者的病理类型、治疗经过及影像报告检查结果,并复习相关文献。结果 5例患者发生SCNSL可分两种类型:3例复发难治患者中枢侵犯,2例初次诊断时合并中枢侵犯。所有患者病理类型均为中高度恶性,其中B细胞性4例,T细胞性1例。4例出现脑实质侵犯,1例出现脑膜侵犯。治疗结果:2例病情完全缓解,1例患者部分缓解持续治疗中,1例死亡,1例失访。结论对具有中枢侵犯高危因素的NHL,需早期进行脑脊液、影像学等检查,早期预防。治疗上建议大剂量甲氨蝶呤(HD-MTX)、全身治疗联合鞘注化疗或放疗。

Objective To improve the understanding of the secondary central nervous system lymphoma( SCNSL),namely,central nervous system involvement in non-Hodgkin lymphoma( NHL). Methods From June 2010 to May 2018,5 NHL patients with SCNSL were collected,whose pathological types,treatment,imaging findings were retrospectively studied,and the related literature were reviewed. Results There were two types of SCNSL in 5 patients: central invasion in3 patients with retreatment and central invasion in 2 patients with initial diagnosis. Pathological types were moderately and poorly differentiated tumor,including 4 cases of B-cell type and 1 case of T-cell type. There were 4 cases of brain parenchymal invasion and 1 case of meningeal invasion. After treatment,there were 2 cases of complete remission,1 case of partial remission,1 case of death and 1 case of being lost to follow-up. Conclusions For NHL as a high risk factor of central invasion,early examination of cerebrospinal fluid,imaging and early prevention are needed. In the treatment,highdose methotrexate( HD-MTX) and systemic therapy combined with intrathecal chemotherapy or radiotherapy are recommended.