Yüksel Erdal, Ufuk Emre, Taşkın Güneş, Canan Tanık, Aysel Tekeşin

Primer santral sinir sistemi lenfoması

Primer santral sinir sistemi lenfoması, beyin ve zarlarını, göz veya spinal kordu tutabilen nadir görülen bir Non-Hodgkin lenfoma türüdür. Primer santral sinir sistemi lenfoması çoğunlukla diffüz büyük B hücreli lenfoma grubundadır ve agresif seyirlidir. Hastalığı düşündüren klinik, görüntüleme ve beyin omurilik sıvısı bulguları olmasına rağmen kesin tanı ve tedavi planlaması için biyopsi gereklidir. Yetmiş üç yaşında erkek hasta, bir aydır ilerleyici başağrısı ve sağ kolda güçsüzlük yakınmaları ile başvurdu. Hasta ileri tetkik ve tedavi için kliniğimize yatırıldı. Manyetik rezonans görüntüleme sonuçları ile santral sinir sistemi lenfoması düşünülen hastaya lomber ponksiyon yapıldı. Lomber ponksiyon incelemelerinde lenfoma lehine bulgu saptanmayan hastaya stereotaktik beyin biyopsisi yapıldı ve patolojik inceleme sonucu ile CD 20 + B hücreli lenfoma tanısı konuldu. Primer santral sinir sistemi lenfoması için MR bulguları tipik olgularda zaman kaybetmeden histopatolojik tanı konulmalı ve tedaviye başlanmalıdır.

Primary central nervous system lymphoma

Primary central nervous system lymphoma is an uncommon non-Hodgkin lymphoma that may occur in brain and meninges, orbita or spinal cord. Primary central nervous system lymphoma is mostly in the diffuse large B cell lymphoma group and agressive crusing. Despite the clinic, imaging, and cerebrospinal fluid findings suggesting the illness, biopsy is necessary for definite diagnosis and treatment planning. A 73-year-old male patient applied with progressive headache for a month and weakness on the right-arm. The patient was hospitalized to our clinic for further examination and treatment. Lumbar puncture was applied the patient who is thought to have central nervous system lymphoma as a result of the magnetic resonans imaging. Stereotactic brain biopsy was performed on the patient who had no evidence of lymphoma in the lumbar puncture examinations and a result of pathologic examination, the CD20+B cell lymphoma was diagnosed. When MR findings are typical for primary central nervous system lymphoma, histopathologic diagnosis should be made without delay and treatment should be started.

Keywords:

Stereotactic biopsy, central nervous system, lymphoma,

PDF

___

1. Wang J, Guo Z, Ma E, Xing D, Qiu B O, Wang Y. Diagnosis and treatment of primary central nervous system lymphoma: a report of nine cases and literature review. Oncol Lett. 2015;9:1795-801.
2. Batchelor T, Loeffler JS. Primary CNS lymphoma. J Clin Oncol. 2006;24:1281-8.
3. Haldorsen IS, Espeland A, Larsson EM. Central nervous system lymphoma: characteristic findings on traditional and advanced imaging. AJNR Am J Neuroradiol. 2011;32:984–92.
4. Zhang D, Hu LB, Henning TD, Ravarani EM, Zou LG, Feng XY et al. MRI findings of primary CNS lymphoma in 26 immunocompetent patients. Korean J Radiol. 2010;11:269-77.
5. Phillips EH, Fox CP, Cwynarski K. Primary CNS lymphoma. Curr Hematol Malig Rep. 2014;9:243-53.
6. Rubenstein J, Ferreri AJ, Pittaluga S. Primary lymphoma of the central nervous system: epidemiology, pathology and current approaches to diagnosis, prognosis and treatment. Leuk Lymphoma. 2008;49(Suppl 1):43-51.
7. Bhagavathi S and Wilson JD: Primary central nervous system lymphoma. Arch Pathol Lab Med. 2008;132:1830-4.
8. Hochberg FH, Miller DC. Primary central nervous system lymphoma. J Neurosurg. 1988;68:835-53.
9. Hatipoğlu HG, Ergüngör MF, Dağlıoğlu E, Üzüm N, Cılız D, Yüksel E. Primer santral sinir sistemi lenfoması: difüzyon ağırlıklı görüntüleme ve spektroskopi. Journal of Neurological Sciences [Turkish]. 2010;27:98-103.
10. Schabet M. Epidemiology of primary CNS lymphoma. J Neurooncol. 1999;43:199-201
11. Burhan F, Murat Ö. Primer merkezi sinir sistem lenfomaları. HematoLog. 2013;3:382-94.
12. Haldorsen IS, Krakenes J, Krossnes BK, Mella O, Espeland A. CT and MR imaging features of primary central nervous system lymphoma in Norway, 1989– 2003. AJNR Am J Neuroradiol. 2009;30:744–51.
13. Commins DL. Pathology of primary central nervous system lymphoma. Neurosurg Focus. 2006;21:E2
14. Salzman K: Primary CNS lymphoma. In Diagnostic Imaging. Brain (Eds A Osborn, KL Salzman, AJ Barkovich A):106-22. Baltimore, Lippincott Williams Wilkins, 2004.
15. Porter AB, Giannini C, Kaufmann T, Lucchinetti CF, Wu W, Decker PA et al. Primary central nervous system lymphoma can be histologically diagnosed after previous corticosteroid use: a pilot study to determine whether corticosteroids prevent the diagnosis of primary central nervous system lymphoma. Ann Neurol. 2008;63:662-7.
16. Yap KK, Sutherland T, Liew E, Tartaglia CJ, Pang M, Trost N. Magnetic resonance features of primary central nervous system lymphoma in the immunocompetent patient: a pictorial essay. J Med Imaging Radiat Oncol. 2012;56:179-86.