Mori Yoshimasa, Yamamoto Koh, Ohno Ako, Fukunaga Masaharu, Nishikawa Atsushi
Radiation Oncology and Neurosurgery, Center for Advanced Image-guided Radiation Therapy, Shin-yurigaoka General Hospital, Kawasaki, JPN.
Neurosurgery, Shin-yurigaoka General Hospital, Kawasaki, JPN.
Cureus. 2019 Sep 16;11(9):e5675. doi: 10.7759/cureus.5675.
A 50-year-old man presented with dizziness and hearing disturbance in the right ear. Magnetic resonance imaging (MRI) revealed a well-enhanced mass lesion in the right cerebellopontine (CP) angle that appeared to originate in the cerebellum. A surgical specimen obtained at the subtotal resection with craniotomy revealed a diffuse large B-cell lymphoma (DLBCL). During the three courses of chemotherapy with high-dose methotrexate (MTX) with leucovorin rescue, he developed a right abducens palsy, left oculomotor palsy, left facial palsy, right trigeminal sensory disturbance, and paraparesis. Although the brain MRI showed that the CP angle tumor had disappeared completely following chemotherapy, enhanced lesions along the cauda equina were detected on a lumbar spine MRI. FDG-PET (18 F-fluorodeoxyglucose positron emission tomography) revealed multiple high-uptake abnormalities in the cranial nerves and spinal nerves. Tumor cells were found in the cerebrospinal fluid specimen from a lumbar puncture. Craniospinal irradiation was performed, including all the abnormal FDG high-uptake areas, and was effective in relieving the patient's symptoms. On FDG-PET, the high-uptake abnormalities in the peripheral nerves disappeared. However, five weeks after the irradiation, he developed right trigeminal sensory disturbance, hoarseness, dysphagia, and right arm pain. FDG-PET disclosed multiple high-uptake abnormalities in more peripheral portions of the cranial nerves and spinal nerves. Chemotherapy with rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine (Oncovin®), and prednisolone (R-CHOP) was then resorted to which mitigated his symptoms. On follow-up FDG-PET, the high-uptake abnormalities in the peripheral nerves disappeared again.
一名50岁男性出现头晕及右耳听力障碍。磁共振成像（MRI）显示右侧桥小脑角有一个强化明显的肿块病变，似乎起源于小脑。开颅次全切除获取的手术标本显示为弥漫性大B细胞淋巴瘤（DLBCL）。在接受三疗程大剂量甲氨蝶呤（MTX）联合亚叶酸钙解救化疗期间，他出现了右侧展神经麻痹、左侧动眼神经麻痹、左侧面神经麻痹、右侧三叉神经感觉障碍及双下肢轻瘫。尽管脑部MRI显示化疗后桥小脑角肿瘤已完全消失，但腰椎MRI检测到沿马尾有强化病变。氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示颅神经和脊神经有多个高摄取异常。腰椎穿刺脑脊液标本中发现肿瘤细胞。对包括所有FDG高摄取异常区域进行了全脑脊髓照射，有效缓解了患者症状。FDG-PET显示周围神经的高摄取异常消失。然而，照射后五周，他出现了右侧三叉神经感觉障碍、声音嘶哑、吞咽困难及右臂疼痛。FDG-PET显示颅神经和脊神经更外周部分有多个高摄取异常。随后采用利妥昔单抗、环磷酰胺、盐酸多柔比星、长春新碱（Oncovin®）和泼尼松龙（R-CHOP）化疗，症状得到缓解。随访FDG-PET显示周围神经的高摄取异常再次消失。
