Miranda R N, Glantz L K, Myint M A, Levy N, Jackson C L, Rhodes C H, Glantz M J, Medeiros L J
Department of Pathology, Brown University School of Medicine, Providence, Rhode Island, USA.
Arch Pathol Lab Med. 1996 Mar;120(3):254-60.
Non-Hodgkin's lymphomas rarely present as a localized mass involving the dura. In this report we describe the clinical, histologic, and immunohistochemical features of five cases of stage IE non-Hodgkin's lymphoma involving the dura.
Four women and one man, 36 to 67 years of age (median 50.6 years).
Myelography and magnetic resonance imaging scans revealed discrete expansile masses involving the dura of the cervical, thoracic, and lumbar regions of the spinal cord and the frontal lobe of the brain. Histologically, the tumors were classified in the Working Formulation as small lymphocytic (2), diffuse large cell (2), and large cell immunoblastic (1) (anaplastic large cell lymphoma). Four tumors were of B-cell lineage and the anaplastic large-cell lymphoma was of T-cell lineage. The two small lymphocytic neoplasms had immunoglobulin heavy-chain gene rearrangements as shown by either Southern blot hybridization or the polymerase chain reaction. Four patients underwent decompression laminectomy; three received spinal radiation; two received chemotherapy (one intrathecal, one systemic) for lymphocytosis of the cerebrospinal fluid. The dural mass overlying the frontal lobe was excised and focally irradiated. Clinical follow-up was available for all patients. Four patients were alive 12 to 40 months after diagnosis and showed no evidence of recurrent or disseminated disease. The patient with anaplastic large-cell lymphoma died 10 days after laminectomy, secondary to pulmonary thromboemboli.
We conclude that non-Hodgkin's lymphomas of varied histologic types and of either B- or T-cell lineage may rarely present as a stage IE dural mass. These lesions appear to have a good initial response to treatment; however, longer clinical follow-up is necessary to assess the incidence of relapse and final outcome.
非霍奇金淋巴瘤很少表现为累及硬脑膜的局限性肿块。在本报告中，我们描述了5例累及硬脑膜的IE期非霍奇金淋巴瘤的临床、组织学和免疫组化特征。
4名女性和1名男性，年龄36至67岁（中位年龄50.6岁）。
脊髓造影和磁共振成像扫描显示，在脊髓颈段、胸段和腰段以及脑额叶的硬脑膜处有离散的膨胀性肿块。组织学上，根据工作分类法，肿瘤分为小淋巴细胞型（2例）、弥漫大细胞型（2例）和大细胞免疫母细胞型（1例，间变性大细胞淋巴瘤）。4例肿瘤为B细胞谱系，间变性大细胞淋巴瘤为T细胞谱系。通过Southern印迹杂交或聚合酶链反应显示，2例小淋巴细胞性肿瘤有免疫球蛋白重链基因重排。4例患者接受了减压性椎板切除术；3例接受了脊髓放疗；2例因脑脊液淋巴细胞增多接受了化疗（1例鞘内化疗，1例全身化疗）。切除了额叶上方的硬脑膜肿块并进行了局部放疗。所有患者均有临床随访。4例患者在诊断后12至40个月存活，未发现复发或播散性疾病的证据。间变性大细胞淋巴瘤患者在椎板切除术后10天死于肺血栓栓塞。
我们得出结论，不同组织学类型以及B或T细胞谱系的非霍奇金淋巴瘤很少表现为IE期硬脑膜肿块。这些病变似乎对治疗有良好的初始反应；然而，需要更长时间的临床随访来评估复发率和最终结局。
