Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 81675 Munich, Germany.
Department of Neurosurgery, Hôpitaux Universitaires de Genève, 1205 Geneva, Switzerland.
Curr Oncol. 2021 Oct 2;28(5):3891-3899. doi: 10.3390/curroncol28050332.
Manifestation of malignant lymphoma in the spine is rare; there have only been a few cases reported in the literature. Due to its rarity, there is no gold standard for the management of patients suffering from spinal lymphoma manifestations. Methods: We retrospectively reviewed the data for 37 patients (14 female, 23 male) with malignant lymphoma in the spine receiving intervention in our center from March 2006 until June 2020. Neurological impairment, pain, diagnostics, and/or surgical instability were the criteria for surgery in this patient cohort. Otherwise, only CT-guided biopsies were conducted. Analysis of the patient cohort was based on the Karnofsky performance status scale (KPSS), location of the lesion, spinal levels involved, spinal instability neoplastic score (SINS), surgical treatment, histopathological workup, adjuvant therapy, and overall survival. The following surgical procedures were performed: posterior stabilization and decompression in nine patients; decompression and/or tumor debulking in 18 patients; a two-staged procedure with dorsal stabilization and vertebral body replacement in four patients; decompression and biopsy in one patient; a two-stage procedure with kyphoplasty and posterior stabilization for one patient; posterior stabilization without decompression for one patient; a vertebroplasty and cement-augmented posterior stabilization for one patient; and a CT-guided biopsy alone for two patients. Twenty-one patients (56.78%) had ≥1 lesion in the thoracic spine, 10 patients (27.03%) had lesions in the lumbar spine, two patients had lesions in the cervicothoracic junction, two patients had lesions in the thoracolumbar junction, one patient had a lesion in the lumbosacral junction, and one patient had a lesion in the sacrum. The diagnoses of the histopathological workup were diffuse large B-cell lymphoma in 23 (62.16%) cases, indolent lymphoma in 11 (29.74%) cases, anaplastic T-cell lymphoma in one case (2.70%), T-cell lymphoma in one case (2.70%), and Burkitt lymphoma in one (2.70%) case. The median overall survival was 7.2 months (range 0.1-266.7 months). Pre- and postoperative KPSS scores were 70% (IQR 60-80%). Manifestation of malignant lymphomas in the spine is rare. Similar to the approach taken for spine metastases, a surgical intervention in cases of neurological impairment or manifest or potential instability is indicated, followed by chemoimmunotherapy and radiotherapy.
恶性淋巴瘤在脊柱中的表现较为罕见，文献中仅有少数病例报道。由于其罕见性，对于脊柱淋巴瘤表现的患者，目前尚无金标准的治疗方法。方法：我们回顾性分析了 2006 年 3 月至 2020 年 6 月在我中心接受干预的 37 例脊柱恶性淋巴瘤患者（14 例女性，23 例男性）的数据。神经功能障碍、疼痛、诊断和/或手术不稳定是该患者组手术的标准。否则，仅进行 CT 引导下活检。对患者组的分析基于卡诺夫斯基绩效状态评分（KPS）、病变部位、受累脊柱节段、脊柱不稳肿瘤评分（SINS）、手术治疗、组织病理学检查、辅助治疗和总生存率。进行了以下手术：9 例患者行后路稳定和减压；18 例患者行减压和/或肿瘤切除；4 例患者行背侧稳定和椎体置换的两阶段手术；1 例患者行减压和活检；1 例患者行两阶段经皮椎体后凸成形术和后路稳定；1 例患者行后路稳定无减压；1 例患者行椎体成形术和骨水泥增强后路稳定；2 例患者仅行 CT 引导下活检。21 例（56.78%）患者的胸段脊柱有≥1 个病变，10 例（27.03%）患者的腰椎有病变，2 例患者的颈胸交界处有病变，2 例患者的胸腰椎交界处有病变，1 例患者的腰骶交界处有病变，1 例患者的骶骨有病变。组织病理学检查的诊断结果为弥漫性大 B 细胞淋巴瘤 23 例（62.16%），惰性淋巴瘤 11 例（29.74%），间变性 T 细胞淋巴瘤 1 例（2.70%），T 细胞淋巴瘤 1 例（2.70%），伯基特淋巴瘤 1 例（2.70%）。中位总生存期为 7.2 个月（范围 0.1-266.7 个月）。术前和术后的 KPS 评分分别为 70%（IQR 60-80%）。恶性淋巴瘤在脊柱中的表现较为罕见。与脊柱转移瘤的治疗方法类似，对于有神经功能障碍或有明显或潜在不稳定的患者，建议进行手术干预，然后进行化疗免疫治疗和放疗。
