Analysis Of Clinical Features Of Primary Central Nervous System Lymphoma

Background and Objective Primary central nervous system lymphoma is a rare malignant tumor in the brain,In recent years,the incidence of the disease has shown a significant upward trend.PCNSL is highly invasive,with a high degree of malignancy,rapid progression of the disease,poor treatment,high mortality and disability,and poor prognosis.Because PCNSL clinical symptoms and various imaging findings are atypical,leading to early diagnosis of PCNSL is difficult,and easy to be misdiagnosed,delaying the optimal timing of treatment,affecting the prognosis of patients.This study aims to provide theoretical support and clinical basis for improving the early diagnosis,differential diagnosis and prognosis evaluation of PCNSL through analysis and summary of various clinical data of PCNSL.Methods A retrospective analysis of 30 cases of PCNSL patients diagnosed by pathology from June 2008 to December 2018 in the Department of Neurosurgery,Ningxia Medical University General Hospital.Collecting general data,clinical manifestations,imaging data,laboratory tests,pathological data,treatment plans,follow-up results,etc.,and systematically summarizing them.Statistical analysis was performed on the collected data using spss22.0 software,and the Kaplan-Meier method was used for survival analysis.Relevant factors that may affect the prognosis of patients such as age,gender,number of lesions,choice of treatment options,Karnofsky(KPS)score,Ki-67 proliferation index,degree of edema around the lesion,and course of disease were performed by Log-rank method test.Results Among the 30 patients with PCNSL,males were more common than females,including 18 males and 12 females.The patient's age range was 16-77 years old,with a median age of 59 years and an average age of 56.03 years.Among them,14 cases were older than 60 years old,and 16 cases were younger than 60 years old.There were 21 patients with a preoperative KPS score greater than 70,and 9 patients with a score less than or equal to 70.The clinical manifestations of the patients were similar to those of other intracranial tumors,and no significant differences were observed.On the basis of the patient's preoperative imaging examination,according to the number of tumor lesions: 23 cases of single lesions,7cases of multiple lesions;according to the classification of tumors: 25 cases on the screen,2cases under the curtain,both on-screen and under the curtain 3 cases.The brain-enhanced magnetic resonance scan showed more uniform and obvious enhancement.5 patients may be characterized by the characteristic "umbilical concave sign","Sharp angle sign" and "spike angle sign".Brain weight diffusion imaging(DWI)is a high signal or a slightly higher signal.Magnetic resonance spectroscopy(MRS)showed typical choline(Choline,Cho)peak increased and creatine(Cre-atine,Cr)peak decreased,nitrogen-acetylaspartate(N-acetylaspartate,NAA)The peak is lowered.Among them,16 patients showed typical lipid(Lipids,Lip)peak or combined with Lactate(Lac)peak on MRS.Obvious abnormalities were not found in the laboratory tests.Among them,14 patients completed the cytology test of cerebrospinal fluid,and all of them were not found to be tumor cells.Histopathological examination of 29 patients were diffuse large B-cell lymphomas(DLBCL),and 1 patient was a T-cell-derived lymphoma.In the treatment,23 patients underwent total or subtotal tumor resection,and 7 patients underwent stereotactic biopsy.There were 13 patients who underwent radiotherapy and chemotherapy after surgery,7 patients who underwent radiotherapy after surgery,and 8 patients who underwent chemotherapy after surgery.Only 2 patients received simple surgery.The median survival time of the 30 patients enrolled was 17 months,the longest survival period was 45 months,and the shortest was only 1 month.Conclusion Cranial magnetic resonance enhancement,DWI,MRS and other special imaging examinations may have certain reference value for early diagnosis and differential diagnosis of PCNSL,but the diagnosis of PCNSL still relies on biopsy pathology analysis.Surgery combined with radiotherapy and chemotherapy can significantly prolong the survival of patients and improve the prognosis of patients.The age of the patient,the number of lesions,the choice of treatment regimen,and the proliferation index of Ki-67 are relevant factors influencing the prognosis of the patient.