O'Neill B P, Kelly P J, Earle J D, Scheithauer B, Banks P M
Neurology. 1987 Jul;37(7):1160-4. doi: 10.1212/wnl.37.7.1160.
Primary CNS lymphoma was diagnosed in 13 patients after stereotaxic biopsy of indeterminate intracerebral mass lesions. Two patients also had laser extirpation of CT-visible tumor. The group consisted of 10 men and 3 women, aged 17 to 81 (mean, 55 years; median, 60 years). The lesions on CT were characteristically hyperdense, homogeneously contrast-enhancing, and associated with mild to moderate mass effect. Five patients had more than one lesion visible on CT. Complete staging procedures for occult systemic lymphoma were negative in all 13 patients. The majority (eight) of the tumors were of the diffuse, large-cell type. Five biopsy specimens underwent special immunostaining as a supplemental diagnostic effort. Two patients with small lymphocytic tumors demonstrated features consistent with T cell phenotype. Two patients with diffuse, large-cell tumors were confirmed as B cell phenotype by monotypic immunoglobulin light chain content. Primary CNS lymphomas represent a treatable group of primary brain tumors. Because of their tendency to develop in deep cerebral regions, they are often inaccessible to conventional neurosurgical techniques. We propose that stereotaxic neurosurgery can provide safe and accurate diagnosis, which is a prelude to planning comprehensive management.
13例患者经立体定向活检确诊为原发性中枢神经系统淋巴瘤，活检对象为脑内性质不明的占位性病变。2例患者还接受了CT可见肿瘤的激光切除。该组患者包括10名男性和3名女性，年龄在17至81岁之间（平均55岁；中位数60岁）。CT上的病变特征为高密度、均匀强化，并伴有轻至中度的占位效应。5例患者在CT上可见多个病变。所有13例患者隐匿性系统性淋巴瘤的完整分期检查均为阴性。大多数（8例）肿瘤为弥漫性大细胞型。5份活检标本进行了特殊免疫染色作为补充诊断手段。2例小淋巴细胞肿瘤患者表现出与T细胞表型一致的特征。2例弥漫性大细胞肿瘤患者通过单型免疫球蛋白轻链含量确诊为B细胞表型。原发性中枢神经系统淋巴瘤是一组可治疗的原发性脑肿瘤。由于它们倾向于在脑深部区域发生，传统神经外科技术往往难以触及。我们认为立体定向神经外科手术能够提供安全准确的诊断，这是规划综合治疗的前奏。
