原发性中枢神经系统淋巴瘤22例临床分析

目的探讨原发性中枢神经系统淋巴瘤（PCNSL）的临床诊断、治疗方法及预后。方法回顾总结我院22例PCNSL患者的临床表现、影像学特征、治疗方法及预后。结果肿瘤位于颅内17例，患者主要以颅内压增高及癫痫等症状为主；位于脊髓内5例．患者以节段性的腰背部疼痛及压迫症状为主。手术全切15例，立体定向活检7例，术后均行常规放、化疗。随访14例，其中5例立体定向活检患者，平均生存期为15．8个月：8例颅内手术切除患者，平均生存期为44．5个月，有3例肿瘤全切患者生存期〉5年，最长者已达13年；1例髓内肿瘤患者生存期为7个月。结论PCNSL在影像学上大多呈团块状、明显且较均匀的强化，大多周围有较明湿的水肿带．手术切除并行放、化疗可使部分病人获得长期生存：而立体定向活检并行放、化疗的．疗效稍筹．

Clinical Analysis of Primary Central Nervous System Lymphoma (Report of 22 Cases)

Objective To study the clinical diagnosis, treatment of primary central nervous system lymphoma (PCNSL) and prognosis in the patients with PCNSL. Methods The clinical data of 22 patients with PCNSL, including clinical manifestation, imaging features, and the data of treatment and prognosis, treated in our hospital were analyzed retrospectively. Results Of 22 patients with PCNSL, 17 suffered from intracranial PCNSL and 5 from intraspinal PCNSL. The increase in intracranial pressure and epilepsy were the main clinical manifestations in the patients with intracranial PCNSL. Backache was the main clinical manifestation in the patients with intraspinal PCNSL. The tumor was enhanced homogeneously on CT and MR imagings and there was significant edema zones around PCNSL. Of 22 patients with PCNSL, 15 received surgical total removal of the tumor, and 7 only stereotactic biopsy. All the patients received routine chemotherapy and radiotherapy after the operation. Of 14 patients followed up, 5 undergoing stereotactic biopsy survived averagely for 15.8 months, 8 undergoing the surgery averagely for 44.5 months and 1 suffering from intraspinal PCNSL for 7 months. The 3 patients undergoing the surgery survived more than 5 years, and 1 of them survives still up to now more than 13 years. Conclusions Most PCNSL were mass-like lesions and enhanced significantly and homogeneously on imaging. There was a significant edema zone around the PCNSL. Some patients with PCNSL whom received removal of tumors, chemotherapy and radiotherapy can survive for a long period. The prognosis is bad in the patients with PCNSL whom received chemotherapy and radiotherapy after the biopsy.