Analysis Of The Diagnosis,Treatment And Prognosis Of Primary Central Nervous System Lymphoma

Objective: The incidence of primary central nervous system lymphoma(PCNSL)is low,but it has a rising trend in recent years.Due to the lack of specificity and typicality in the clinical features and imaging manifestations,the misdiagnosis rate is high and the prognosis is poor.This study reviewed the clinical data and treatment experience of PCNSL patients.The diagnosis and treatment characteristics were discussed and the prognosis was analyzed to provide the reference for clinic.Clinical data and methods: Through a retrospective analysis of 19 cases of PCNSL in the department of neurosurgery at China-Japan union hospital of Jilin university between December 2011 and December 2017.The characteristics of diagnosis and treatment can be analyzed and summarized.Results: Among the 19 patients,12 were males,7 were females,and the age was 29~76 years old,with an average age of 56 years old,and 8 cases aged over 60 years old,and 11 cases below 60 years old.The clinical manifestations of PCNSL are complex.There were 4 cases of headache,6 cases of motor disorder,4 cases of sensory disorder,3 cases of language impairment,2 cases of memory impairment,2 cases of epilepsy and 1 case of visual impairment.All patients underwent CT and MRI scanning and enhanced imaging.The tumor was located in the intracranial area of 89.5%,and the lesion was located at the spinal cord of 10.5%.Most of them were single lesions,one of which was multiple lesions.ALL of the pathological examination of PCNSL was lymphoma,and the diffuse large B cell lymphoma is common.Most patients underwent stereotactic surgery to clarify the pathology,or to relieve the symptoms of intracranial hypertension with surgical treatment.In addition to 1 patient died after diagnosis of lymphoma,the patients were treated with a large dose of methotrexate as the main chemotherapy,accompanied by radiotherapy.Results follow-up: Patients with radiotherapy and chemotherapy combined lived an average of 33 months,patients with chemotherapy alone lived an average of 20 months.One patient with radiation alone survived for 10 months.The survival period of the 3 patients who continued radiotherapy and chemotherapy after focal resection was 13 months,25 months and 28 months.One patient survived for 5 months without radiotherapy and chemotherapy after focal resection.Conclusion:1、 PCNSL is a rare malignant tumor with multiple clinical manifestations and difficult early diagnosis.2、 PCNSL imaging lacks specificity,and the diagnosis needs to be based on pathology and immunohistochemical examination.3、 For patients with high suspicion of PCNSL,stereotopic biopsy should be performed in the early stage.4、 Simple surgical treatment has no significance for improving the survival period of patients,and whether the tumor is fully cut has no obvious effect on the prognosis of patients.5、 After the postoperative pathologic diagnosis of PCNSL,the comprehensive treatment based on radiotherapy and chemotherapy should be performed early,so as to improve the survival quality of patients and significantly prolong the survival period.