老年期原发性中枢神经系统淋巴瘤的临床研究

目的 探讨老年期原发性中枢神经系统淋巴瘤的临床特点和诊疗措施.方法 老年原发性中枢神经系统淋巴瘤患者36例,均行头部CT和/或MRI检查,经组织病理学检查证实;治疗分为手术切除加放、化疗组(外科联合治疗组)和放、化疗组.治疗后随访并对两组治疗方法的生存率进行log-rank检验.结果 头部CT显示病灶呈稍高密度或等密度,边界不清,周边可见水肿,增强后强化明显;MRI:T1像为低或等信号、T2像为稍高或等信号影,周围多有呈高信号的水肿带,增强扫描后病灶都有明显的均匀强化或边缘增强.病理学检查32例为B细胞淋巴瘤,4例为T细胞淋巴瘤;36例患者均无HIV感染,免疫功能正常.外科联合治疗组和放、化疗组中位生存时间分别为19、14个月,两组治疗方法对生存率的影响差异无统计学意义(P＞0.05).结论 老年期原发性中枢神经系统淋巴瘤患者的临床表现缺乏特异性,容易误诊,应注意与胶质瘤、转移瘤、脑膜瘤等鉴别.对多病灶的老年患者进行手术治疗的益处不大,建议通过及早MRI等检查并推广立体定向活检术来减少不必要的手术.

The clinical investigation of senile primary central nervous system lymphoma

Objective To investigate the clinical characteristics,diagnosis and treatment of senile primary central nervous system lymphoma.Methods The patients were divided into two groups,one group of the patients underwent chemotherapy and radiotherapy treatment following surgical resection,the other received a combined treatment of chemotherapy and radiotherapy only.The survival were analyzed with log-rank test.Results All of the lesions showed the iso-to slightly high density in the CT scan,and the boundary was unclear,surrounded by edema.Contrast enhancement was found in all of the patients.MRI showed iso-to low T1 and iso-to slightly high T2 signal intensity to the adjacent gray matter.The lesions were surrounded by the edema belt.Contrast enhancement such as rim enhancement or homogeneous enhancement was found in all.The pathological diagnosis was B cell lymphoma(n=32)and T cell lymphoma(n=4).In addition,all of the patients were excluded out of HIV infection and their immune function was normal.The median survival time of the group receiving surgery combination treatment and the group receiving just chemotherapy and radiotherapy were 19 months and 14 months,respectively.There was no significant statistics between the survival time of the two groups.Conclusion It is necessary to differentiate primary central nervous system lymphoma from glioma,metastatic tumor,meningoma,and so on.The surgical resection seems no help for those senile central nervous system lymphoma patients with multi-focus.The diagnosis should be suspected after MRI and obtained by stereotactic biopsy in order to avoid an unnecessary extend of surgery in primary central nervous system lymphoma(PCNSL).