Heider A, Engels B, Hartmann-Klosterkötter U, Kress M, Niederle N
Medizinische Klinik III, Städtischen Krankenhauses Leverkusen.
Dtsch Med Wochenschr. 1993 Jan 12;118(1-2):19-22. doi: 10.1055/s-2008-1059296.
Partial remission of a centroblastic non-Hodgkin's lymphoma, clinical stage IV A, in a 79-year-old man was achieved by six courses of chemotherapy with epirubicin, cyclophosphamide and vincristine. The only residual finding was a palpable small cervical lymphoma. After a treatment pause of about 6 weeks increasing hypersalivation set in which ultimately made food intake impossible and led to a breakdown in the patient's general state. Findings in the region of the head, neck, throat and the base of the skull were unremarkable, but cerebrospinal fluid contained 1300/3 cells, almost all of them lymphoblasts. After five intrathecal injections of at first 15 mg methotrexate and 4 mg dexamethasone each, followed by five more with 40 mg cytarabine added to them, the CSF cell count became normal. At the same time salivation clearly decreased and food intake became once again possible. The patient died 5 months later from hypercalcaemia due to osseous infiltrations. Until his death there was no recurrence of the hypersalivation as the cardinal sign of meningeal carcinomatosis.
一名79岁男性，临床分期为IV A期的中心母细胞性非霍奇金淋巴瘤，通过接受六个疗程的表柔比星、环磷酰胺和长春新碱化疗实现了部分缓解。唯一残留的体征是可触及的颈部小淋巴瘤。在约6周的治疗间歇期后，出现唾液分泌过多且逐渐加重，最终导致无法进食，并使患者全身状况恶化。头、颈、咽喉及颅底部位的检查未见异常，但脑脊液中细胞数为1300/3，几乎全部为淋巴母细胞。最初鞘内注射15mg甲氨蝶呤和4mg地塞米松各5次，随后5次添加40mg阿糖胞苷，脑脊液细胞计数恢复正常。与此同时，唾液分泌明显减少，再次能够进食。患者5个月后因骨质浸润导致高钙血症死亡。直至去世，作为脑膜癌病主要体征的唾液分泌过多未再复发。
