Clinical Analysis Of Primary Central Nervous System Lymphoma (with 30 Cases Report)

Objective:To investigate the diagnosis,treatment and prognosis of primary central nervous system lymphoma (PCNSL) by analyzing the clinical manifestations, imaging features, and pathological characteristics of immunocompetent patients with PCNSL and improve the recognization of PCNSL in clinic.Methods:Thirty cases with pathologically confirmed PCNSL were treated in our hospital from Jan 2000 to nov 2008. The clinical characteristics, laboratory, imaging, pathological data and the treatments were reviewed retrospectively. SPSS13.0 statistical analysis software was used to compare the methods of treatment. The survival curves were calculated according to the Kaplan-Meier method and compared the Log-rank test.Results:There were 18 men and 12 women,the ratio is 1.5:1.The age of the patients ranged from 19 to 73 years old (median age=54.9). 22 of these patients'age was more than 50 years old (73.3%). PCNSL often appeared with nonspecific symptoms, such as elevated intracranial pressure and nerve dysfunction, leading to a relatively high misdiagnosis rate. Computed tomography (CT) and magneticresonance image (MRI) showed periventricular tumor with space- occupying effect, clear margins and moderate perifocal edema. Obvious homogeneous mass-like or nodular enhancement was seen on enhanced MRI, the presence of"incision sign"and"angular sign"were more specific,All cases were B-cell lymphoma.Most of them were diffuse large B-cell lymphoma.All of the 30cases were given surgical treatment including total resection or subtotal resection.Postoperatively,14cases received chemotherapy only.while 8 cases received both radiotherapy and chemotherapy after surgery.Kaplan-Meier analysis showed that the median survival time(MST) was 32.0 months and the 2-year survival rate was 46.7% across the whole group. Log-Rank test revealed that the survival time shows statistical difference between the Group received surgery only and the Group received both surgery and chemotherapy. Statistical difference also existed between the Group received surgery only and the Group received surgery combined with chemotherapy and radiotherapy(.P<0.05). there were no statistical difference between the Group received total resection and the Group received subtotal resection(P>0.05).Conclusion:1,PCNSL is a rare highly malignant CNS tumor. It has diversify clinical manifestations,but no specific imaging performance,so it is easily misdiagnosed. The pathological examination might be the only reliable method to confirm PCNSL. Early detection,diagnosis and giving combined modality therapy as early as possible could be more important for improving the prognosis of the PCNSL patiens. Relative specificity clinical manifestations and characteristic imaging features may be helpful for the early diagnosis.MRI exam is more helpful especially.Obvious homogeneous mass-like or nodular enhancement was seen on enhanced MRI,the presence of"incision sign","umbilication"and"angular sign"were more specific.At the same time, combining with some other new auxiliary examination,such as DWI,1H-MRS,PET,SPECT, can contribute a lot to accurate preoperative diagnosis of PCNSL. 2,When conditions permit PCNSL suspected in neurologic imaging must be confirmed via stereotactic biopsy as soon as possible. The main objective of surgical therapy is to relieve the intracranial hypertension and the further damage to cranial nerve function caused by the tumor and darity the final diagnosis.But surgical resection alone is of no good to improve the survival of patients with PCNSL. Whether total resection did not significantly influence the prognosis of PCNSL.The patients of PCNSL should be taken to radiotherapy and chemotherapy-based treatment of systemic as soon as the diagnosis of PCNSL was confirmed by the postoperative pathological examination.The combined treatment had been proved to prolong patients' survival period and improve the quality of life significantly.