Tse Teresa P K, Chan Allan N L, Chan Tony K T, Po Y C
Department of Neurosurgery, Princess Margaret Hospital, Lai Chi Kok, Hong Kong.
Hong Kong Med J. 2014 Dec;20(6):541-4. doi: 10.12809/hkmj134095.
Post-transplantation primary central nervous system lymphoma is an uncommon and fatal post-transplant lymphoproliferative disorder. Such lymphomas have been described in only a few case series in the literature. The incidence of this condition is rising with improved survival after organ transplantation. A case of post-transplantation primary central nervous system lymphoma in a young Chinese woman with systemic lupus erythematosus is described here. She presented with right-sided weakness and memory loss after tooth extraction 2 weeks before admission. Contrast computed tomography of the brain demonstrated a contrast rim-enhancing lesion over the left frontal lobe. With a history of recent dental procedure, long-term immunosuppressive therapy and computed tomography findings, cerebral abscess was highly suspected. Emergency operation was performed. Histopathology showed post-transplantation primary central nervous system lymphoma, with cells positive for B-cell marker CD20. Immunosuppressant was stopped and she was treated with radiotherapy and rituximab (anti-CD20 monoclonal antibody). She remained disease-free at 16 months. Post-transplantation primary central nervous system lymphoma is rare with variable presentation and radiological features. We believe rituximab may have a role in the treatment of such lymphomas.
移植后原发性中枢神经系统淋巴瘤是一种罕见且致命的移植后淋巴增殖性疾病。文献中仅有少数病例系列报道过此类淋巴瘤。随着器官移植后生存率的提高，这种疾病的发病率正在上升。本文描述了一名患有系统性红斑狼疮的年轻中国女性发生移植后原发性中枢神经系统淋巴瘤的病例。她在入院前2周拔牙后出现右侧肢体无力和记忆力减退。脑部增强计算机断层扫描显示左额叶有一个边缘强化的病灶。鉴于近期有牙科手术史、长期免疫抑制治疗及计算机断层扫描结果，高度怀疑为脑脓肿。遂进行了急诊手术。组织病理学显示为移植后原发性中枢神经系统淋巴瘤，细胞B细胞标志物CD20呈阳性。停用免疫抑制剂，给予放疗及利妥昔单抗（抗CD20单克隆抗体）治疗。16个月时她仍无疾病复发。移植后原发性中枢神经系统淋巴瘤罕见，临床表现和影像学特征各异。我们认为利妥昔单抗可能在这类淋巴瘤的治疗中发挥作用。
