Clinical Features Of 28 Cases Of Secondary Central Nervous System Lymphoma

Objective: SCNSL is defined as peripheral lymphoma secondary to CNS,also known as metastatic lymphoma.The incidence of SCNSL is low,the prognosis is very poor,and there is no effective summary of its clinical characteristics and treatment plan.The purpose of this study is to analyze and study the source of SCNSL metastasis,pathological classification,symptoms,growth characteristics,treatment methods and prognostic factors involved in CNS,so as to summarize its clinical characteristics and provide reference for the diagnosis and treatment of SCNSL.Methods: The clinical data of patients with SCNSL diagnosed by stereotactic biopsy from January 2013 to January 2018 in the former Navy General Hospital of the Sixth Medical Center of PLA General Hospital were classified and studied.Result:1.28 patients with SCNSL were enrolled,aged 53.75±13.12 years.The follow-up time was 14.75 ±12.64 months,and the time from primary disease to secondary disease was 46.96 ±35.68 months.There were 16 males and 12 females.2.There were 24 cases of primary disease NHL,2 cases of leukemia,1 case of HL and 1 case of lymphomatoid granulomatosis.The testicular origin of male NHL accounted for 25%,and the breast origin of female NHL accounted for 17.86%.3.There were 25 B cell sources and 3 T cell sources.Pathology of B cell origin was DLBCL.Pathology of T cell origin was HL,Lymphomatoid granulomatosis and T lymphoblastic lymphoma in 1 case each.4.A total of 24 NHL patients with primary diseases were treated with CHOP and RCHOP chemotherapy regimens respectively.According to the influence of treatment regimen,age and sex on the secondary time,independent sample t test was carried out.The P values were 0.514,0.638 and 0.466,respectively,which were higher than 0.05,suggesting that the above three factors had no effect on the secondary time.5.The symptoms of dysphagia,headache and cognitive impairment,dizziness,language impairment and emotional changes are often seen,while ataxia,consciousness impairment and epilepsy are relatively rare.The symptoms of dysphagia,cough and dyspnea are only seen in individual cases.A total of 18 patients underwent lumbar puncture,showing increased intracranial pressure in varying degrees.The examination of cerebrospinal fluid showed a significant increase in protein and white blood cells in varying degrees.6.It can occur in any part of the brain,often with multiple diseases.Most of them show diffuse infiltrative growth.They also easily involve the meninges and ependyma and invade the midline structure.It mainly occurs on the supratentorial side and may involve both the supratentorial side and the subtentorial side,but only in the unilateral cerebral hemisphere.The frontal lobe,corpus callosum,temporal lobe and basal ganglia were the most common involved lobes.It may also involve cerebellum,occipital lobe,insular lobe and semioval center,but it is not common and does not easily involve parietal lobe.7.Six cases were treated with R-IDARAM alone,of which 4 cases were CR,3 cases were CR combined with WBRT,7 cases were CR treated with R-MTX,3 cases were CR,and 2 cases were CR combined with WBRT.Three cases of WBRT were CR,and one case achieved PR by R-MTX combined with interstitial radiotherapy.Comparing the efficacy of R-IDARAM and R-MTX alone,independent sample t test was used,P = 0.185 > 0.05,which did not reflect the difference in efficacy.8.A total of 21 patients died at the end of follow-up.The median overall survival time was 6 months and the overall survival time was 10.10 +9.32 months.Multivariate COX regression analysis indicated that R-IDARAM(P=0.04)could improve the prognosis of patients.Men(P=0.046)and cerebrospinal fluid protein(>600 mg/L)(P=0.043)may be independent risk factors for the prognosis of SCNSL.Conclusion: SCNSL is a secondary malignant lymphoma with peripheral lymphoma metastasis to CNS.The incidence of SCNSL is low.Males often come from testis,females often come from breast,and leukemia can also involve lymphoma lesions in central nervous system.The median time from peripheral lymphoma to central lymphoma was 36.5 months.Rituximab had no effect on peripheral lymphoma.Because of the symptoms of limb movement disorder,headache,cognitive impairment and other symptoms,it mainly occupies multiple spaces in the brain,often involving bilateral cerebral hemispheres at the same time,showing diffuse infiltration and growth,easily involving the meninges,ependyma and midline structures,and tending to occur on the supratentorial and subtentorial simultaneously.The frontal lobes,corpus callosum,temporal lobes and basal ganglia are commonly involved in the brain lobes.Lumbar puncture showed different degrees of increased intracranial pressure,cerebrospinal fluid protein and white blood cells.Tumor cells can be seen in cerebrospinal fluid of some patients.A definite diagnosis depends on biopsy and pathological examination of the lesion,mainly from B cells,but rarely from T cells.DLBCL is a common pathological phenotype.T lymphoblastic lymphoma,classical HL,lymphomatoid granulomatosis and other pathological types can also be seen.Male and cerebrospinal fluid protein(> 600 mg/L)are independent risk factors affecting prognosis.At present,the commonly used treatment is R-MTX,but its toxicity is too high.The newly proposed R-IDARAM chemotherapy regimen can significantly improve the prognosis.