Guzik Grzegorz
Oddział Ortopedii Onkologicznej Szpitala Specjalistycznego w Brzozowie - Podkarpacki Ośrodek Onkologiczny, Polska / Department of Oncological Orthopaedics, Specialist Hospital in Brzozów - Podkarpacie Oncological Centre, Poland.
Ortop Traumatol Rehabil. 2018 Jun 30;20(3):219-227. doi: 10.5604/01.3001.0012.2131.
Non-Hodgkin lymphomas are a heterogeneous group of tumours, with diffuse large B-cell lymphomas (DLBCL) being particularly common. Cases of DLBCLs developing in the central nervous system, especially in the spinal cord, are extremely rare and thus pose significant diagnostic and therapeutic problems, particularly for orthopaedists and neurologists since these are the specialists the patients first consult. The tumours often appear in immunosuppressed patients and standard chemotherapy is ineffective. This paper presents the case of a 44-year-old male with a lymphoma located in the spinal cord at the C7-Th1 level. The symptoms appeared suddenly and progressed rapidly, with dissociated sensory loss and limb paresis being the most pronounced. Imaging studies and the rapid symptom progression suggested neoplastic disease. An emergency surgical procedure was performed in order to decompress the spinal cord and thus limit neurological deficits. Tumour resection allowed for making a diagnosis. By four weeks after the surgery, the tumour had grown larger than before the procedure. Chemotherapy with MTX and Ara-C and intrathecal MTX resulted in full remission. Consolidation was achieved with radiotherapy. Currently, with the low incidence of such tumours, there are no standards of management in patients with DLBCLs of the CNS. The literature contains only a few case reports on successfully treated spinal cord DLBCLs.
非霍奇金淋巴瘤是一组异质性肿瘤，其中弥漫性大B细胞淋巴瘤（DLBCL）尤为常见。DLBCL发生于中枢神经系统，尤其是脊髓的病例极为罕见，因此会带来重大的诊断和治疗难题，对于骨科医生和神经科医生而言更是如此，因为这些患者最初会咨询这些专科医生。这些肿瘤常出现在免疫抑制患者中，标准化疗无效。本文介绍了一例44岁男性患者，其淋巴瘤位于C7 - Th1水平的脊髓。症状突然出现且进展迅速，分离性感觉丧失和肢体麻痹最为明显。影像学检查和症状的快速进展提示为肿瘤性疾病。为了对脊髓进行减压从而限制神经功能缺损，进行了急诊手术。肿瘤切除后得以确诊。术后四周，肿瘤比手术前长得更大。使用甲氨蝶呤（MTX）和阿糖胞苷（Ara - C）进行化疗以及鞘内注射MTX导致完全缓解。通过放疗实现了巩固治疗。目前，由于此类肿瘤发病率较低，中枢神经系统DLBCL患者尚无管理标准。文献中仅有少数关于成功治疗脊髓DLBCL的病例报告。
