Goldstein J, Dickson D W, Rubenstein A, Woods W, Mincer F, Belman A L, Davis L
Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 10467.
Cancer. 1990 Dec 15;66(12):2503-8. doi: 10.1002/1097-0142(19901215)66:12<2503::aid-cncr2820661210>3.0.co;2-6.
Primary central nervous system (CNS) lymphoma, an otherwise rare pediatric tumor, has been reported with increasing frequency in children with acquired immune deficiency syndrome (AIDS). With current therapy, the outcome of this disease is invariably fatal. The authors present a case of primary CNS lymphoma in a 3.5-year-old girl with AIDS who received treatment with total brain irradiation. After treatment, the patient's mental status improved, the seizures resolved, and she had no further progression of her neurologic symptoms until she died of pneumonia 6 months later. The autopsy revealed a necrotic mass at the site of the original tumor. The brain stem and spinal cord, unirradiated, contained lymphomatous lesions. The patient had extensive fibrinoid necrosis and leukoencephalopathy that were consistent with radiation-induced CNS damage. Coexisting AIDS encephalopathy also contributed to the patient's CNS injury. Effective palliation of CNS lymphoma in children with AIDS may be obtained with cranial irradiation. Pediatric AIDS patients may show more severe tissue effects from irradiation than unaffected children.
原发性中枢神经系统（CNS）淋巴瘤是一种相对罕见的儿科肿瘤，据报道在获得性免疫缺陷综合征（AIDS）患儿中的发病率呈上升趋势。采用目前的治疗方法，这种疾病的预后必然是致命的。作者报告了一例3.5岁患AIDS的女童原发性中枢神经系统淋巴瘤病例，该患儿接受了全脑照射治疗。治疗后，患儿的精神状态有所改善，癫痫发作得到缓解，直到6个月后死于肺炎，其神经症状未进一步进展。尸检发现原肿瘤部位有坏死肿块。未接受照射的脑干和脊髓存在淋巴瘤病变。该患者有广泛的纤维蛋白样坏死和白质脑病，与放射性中枢神经系统损伤相符。并存的艾滋病脑病也导致了患者的中枢神经系统损伤。对患有AIDS的儿童进行颅脑照射可有效缓解中枢神经系统淋巴瘤。与未受影响的儿童相比，患儿科艾滋病的患者可能对放疗表现出更严重的组织效应。
