Watanabe Takashi, Kurihara Hideyuki, Magarisawa Satoshi, Shimoda Shigeru, Yoshida Katsue, Ishiuchi Shogo
Department of Neurosurgery, Faculty of Clinical Medicine, University of the Ryukyus, Nakagami-gun, Okinawa, Japan.
Surg Neurol Int. 2010 Nov 27;1:76. doi: 10.4103/2152-7806.73318.
Secondary immune thrombocytopenic purpura (ITP) associated with extranodal B-cell non-Hodgkin's lymphoma (NHL) is extremely rare. The optimal management is not established. We report a first case of ITP in association with extranodal B-cell NHL originating in the lower petroclival region, successfully managed by local tumor control using conventional radiotherapy.
A 75-year-old man presented with a two-month history of hearing loss, hoarseness, and dysphagia. Neuroimaging revealed a large enhanced lesion in the left lower petroclival bone near the jugular foramen. Isolated unilateral parotid lymphadenopathy was also noted. Preoperative laboratory findings were normal, except for elevation of serum soluble interleukin-2 receptor level. A suboccipital craniotomy was performed and a biopsy sample was taken. Histological and immunohistochemical examination confirmed small B-cell lymphoma with plasmacytic differentiation. After initiation of radiotherapy, thrombocytopenia (24,000/µl) rapidly developed. Serological and bone marrow examination confirmed ITP. Prednisone was given at 1 mg/kg/day and radiation therapy was continued. After more than 32Gy, platelet count rapidly normalized. Radiotherapy to the tumor site achieved local tumor control and ITP was resolved. No evidence of recurrence and normal platelet count were confirmed at the two-year follow-up examination.
Local control of the tumor was considered important in the resolution of secondary ITP in association with extranodal NHL of the skull base region.
与结外B细胞非霍奇金淋巴瘤（NHL）相关的继发性免疫性血小板减少性紫癜（ITP）极为罕见。目前尚未确立最佳治疗方案。我们报告首例起源于岩斜下区的结外B细胞NHL合并ITP的病例，通过传统放疗实现局部肿瘤控制，成功治愈。
一名75岁男性，有两个月听力减退、声音嘶哑和吞咽困难病史。神经影像学检查显示左侧岩斜下骨靠近颈静脉孔处有一巨大强化病灶。还发现孤立性单侧腮腺淋巴结肿大。术前实验室检查结果均正常，但血清可溶性白细胞介素-2受体水平升高。行枕下开颅手术并取活检样本。组织学和免疫组化检查确诊为伴有浆细胞分化的小B细胞淋巴瘤。放疗开始后，迅速出现血小板减少（24,000/µl）。血清学和骨髓检查确诊为ITP。给予泼尼松1mg/kg/天，并继续放疗。超过32Gy后，血小板计数迅速恢复正常。对肿瘤部位的放疗实现了局部肿瘤控制，ITP得以缓解。两年随访检查未证实有复发迹象，血小板计数正常。
对于颅底区域结外NHL合并继发性ITP的病例，肿瘤的局部控制被认为对解决ITP至关重要。
