Romero-Guadarrama Mónica Belinda, Aguilar-Martínez Elvira
Pathology Unit, General Hospital of Mexico, O.D., Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP 06726, Mexico, DF.
Acta Cytol. 2010 Sep-Oct;54(5 Suppl):993-7.
Lymphomas that infiltrate the nervous system in children correspond to those of precursor B cells, such as lymphoblastic and Burkitt's lymphoma. In adults, infiltration occurs in mature B-cell lymphomas, such as mantle cell lymphoma, and, rarely, in Hodgkin's lymphoma or peripheral NK/T-cell lymphomas.
We report the case of a 48-year-old man, who two years before death was diagnosed with extranodal nasal NK/T-cell lymphoma nasal in the left nostril. He received radiotherapy and a year later presented tumor activity. He also presented infiltration to the bone marrow and underwent chemotherapy. Afterward, he presented paresthesia and paresis of the lower extremities, difficulty walking, loss of sphincter control, and seizures. Infiltration to the central nervous system was revealed by computed axial tomography, and cytologic study of cerebrospinal fluid revealed malignant lymphoid cells; he then received intrathecal chemotherapy. He died 3 months later.
In Mexico, extranodal nasal NK/T-cell lymphoma occurs frequently. It is highly destructive and tightly related with the Epstein-Barr virus. Infiltration to the central nervous system is rare, and the neoplastic cells can be confused with other tumors, such as metastatic carcinomas.
儿童中浸润神经系统的淋巴瘤与前体B细胞淋巴瘤相对应,如淋巴细胞白血病和伯基特淋巴瘤。在成人中,浸润发生于成熟B细胞淋巴瘤,如套细胞淋巴瘤,很少见于霍奇金淋巴瘤或外周NK/T细胞淋巴瘤。
我们报告一例48岁男性病例,其在死亡前两年被诊断为左鼻孔结外鼻型NK/T细胞淋巴瘤。他接受了放疗,一年后出现肿瘤活动。他还出现骨髓浸润并接受了化疗。之后,他出现下肢感觉异常和麻痹、行走困难、括约肌控制丧失及癫痫发作。计算机断层扫描显示中枢神经系统浸润,脑脊液细胞学检查发现恶性淋巴细胞;随后他接受了鞘内化疗。3个月后他死亡。
在墨西哥,结外鼻型NK/T细胞淋巴瘤较为常见。它具有高度破坏性且与爱泼斯坦-巴尔病毒密切相关。浸润中枢神经系统较为罕见,肿瘤细胞可能与其他肿瘤混淆,如转移性癌。