Alécio-Mattei T, Alécio-Mattei J, Aguiar P H, Ramina R
Pinheiros Neurosurgery Clinic, São Paulo, Brazil.
Neurocirugia (Astur). 2006 Feb;17(1):46-53. doi: 10.1016/s1130-1473(06)70369-4.
Primary central nervous system lymphoma (PCNSL) is a rare pathology and is most often seen in immunodeficient patients. This article presents our casuistic of PCNSL in immunocompetent patients and make a literature review on this issue with focus on recent advances, investigations, and controversies in diagnosis and management of this pathology.
Nine patients operated in the last years in our clinics are analysed in relation to sex, age, time of symptoms, procedures and adjuvant treatment. Posteriorly the results are compared with those in the preview literature.
The age ranged from 44-68 years (middle of 66 years); 62.5% of the patients were female. The mean time of symptoms, when the diagnostic was made, was 3.2 months (range 1-6 months). The most common symptoms were hemiparesis (present in 75% of the patients) headache (37.5%) seizures (25%) and ataxia (25%). The most common localization was the parietal, frontal and temporal lobe surface with 25% of the patients for each localization. Five patients (50%) were treated with stereotactic biopsy, three with surgery (37.5%) and one (12.5%) with both of them. Five patients (62.5%) were submitted to pos-operative radiotherapy as adjuvant treatment. In relation to the histology, the most common cell type was Diffuse B Cells.
This study demonstrated that complete surgical resection followed by radiotherapy have shown good results. In opposition to the literature, the authors regard chemotherapy as a secondary line treatment and recommend its use only in some selected cases.
原发性中枢神经系统淋巴瘤（PCNSL）是一种罕见的病理类型，多见于免疫缺陷患者。本文介绍了我们在免疫功能正常患者中诊治PCNSL的病例，并对该问题进行文献综述，重点关注这种病理类型在诊断和治疗方面的最新进展、研究及争议。
分析过去几年在我们诊所接受手术的9例患者的性别、年龄、症状出现时间、手术方式及辅助治疗情况。随后将结果与既往文献中的结果进行比较。
患者年龄在44 - 68岁之间（平均66岁）；62.5%为女性。确诊时症状出现的平均时间为3.2个月（范围1 - 6个月）。最常见的症状是偏瘫（75%的患者出现）、头痛（37.5%）、癫痫发作（25%）和共济失调（25%）。最常见的病变部位是顶叶、额叶和颞叶表面，每个部位各占25%的患者。5例患者（50%）接受了立体定向活检，3例接受了手术（37.5%），1例同时接受了这两种治疗（12.5%）。5例患者（62.5%）接受了术后放疗作为辅助治疗。在组织学方面，最常见的细胞类型是弥漫性B细胞。
本研究表明，完整手术切除后进行放疗已显示出良好效果。与文献观点相反，作者认为化疗是二线治疗方法，仅建议在某些特定病例中使用。
