Ayşegül ÖZDEMİR OVALIOGLU, Gökhan CANAZ, Abdullah Emre TAÇYILDIZ, Mustafa Levent UYSAL, Talat Cem OVALIOĞLU

Primer santral sinir sistemi lenfomaları: 10 vakanın retrospektif analizi

Amaç: Non-Hodgkin lenfoma (NHL)’nın nadir bir formu olan primer santral sinir sistemi (SSS) lenfoması, agresif ekstranodal SSS’nin yüksek gradlı B hücre neoplazmı olarak tanımlanır. SSS lenfoma insidansı son yıllarda giderek artmaktadır. Genel olarak kötü prognoza sahiptir. Bu çalışmada; primer SSS lenfoması tanısı alan hastaların klinik, patolojik, immünhistokimyasal ve radyolojik özellikleri literatür eşliğinde değerlendirmesi amaçlanmıştır. Gereç ve yöntem: Mayıs 2011 ile Ocak 2017 tarihleri arasında primer SSS lenfoma tanısı patolojik olarak doğrulanmış 10 hasta retrospektif olarak incelendi. Bulgular: SSS lenfomalı 10 hastanın 7 (%70)’si kadın 3 (%30)’ü erkekti. Tüm hastaların tanı konulduğundaki ortalama yaşları 59,1±13,98 idi. En sık yerleşim yeri; 8 hastada (%80) bazal ganglia bölgesi olup, 3 hastanın (%30) çoklu intrakranyal kitleleri vardı. 8 hastada (%80) sterotaksik beyin biyopsisi, 2 hastada (%20) kranyotomi le tümör rezeksiyonu yapıldı. Tümü non-Hodgkin B hücreli lenfoma olan hastaların 10’u da (%100) diffüz büyük B hücreli lenfoma idi. Tüm vakalarda CD20 için diffüz ve kuvvetli pozitiflik görüldü. İmmün yetmezlik hiçbir hastada yoktu. Sonuç: Kötü prognoza sahip olan primer SSS lenfoması sıklıkla 55 yaşın üzerinde görülür. Diffüz büyük B-hücreli lenfoma en sık alt tip olup bazal ganglia bölgesi en sık yerleşim yeridir.

Primary central nervous system lymphomas: retrospective analysis of 10 cases

Purpose: Primary central nervous system (CNS) lymphoma, a rare form of non-Hodgkin's lymphoma (NHL), is defined as high-grade B cell neoplasm of aggressive extranodal CNS. The incidence of CNS lymphoma has been increasing in recent years. In general, it has a poor prognosis. The aim of this study is to evaluate the clinical, pathological, immunohistochemical and radiological features of patients with primary CNS lymphoma in the light of literature. Materials and methods: Between May 2011 and January 2017, 10 patients with pathologic confirmation of primary CNS lymphoma were retrospectively reviewed. Results: Of 10 patients with CNS lymphoma, 7 (70%) were female and 3 (30%) were male. The mean age of all patients at diagnosis was 59.1±13.98 years. The most common settlements; eight patients (80%) had basal ganglia and 3 patients (30%) had multiple intracranial masses. Sterotaxic brain biopsy was performed in 8 patients (80%) and tumor resection was performed by craniotomy in 2 patients (20%). All of the patients with non-Hodgkin B cell lymphoma had diffuse large B cell lymphoma in 10 (100%). All cases had diffuse and strong positivity for CD20. None of the patients had immunodeficiency. Conclusion: Primary CNS lymphoma with a poor prognosis is frequently seen over 55 years of age. Diffuse large B-cell lymphoma is the most common subtype and basal ganglia is the most common site.

PDF

___

Wang CC, Carnevale J, Rubenstein JL. Progress in central nervous system lymphomas. Br JHaematol 2014;166:311-325. https://doi.org/10.1111/bjh.12938
Bhagavathi S, Wilson JD. Primary central nervous system lymphoma. Arch Pathol Lab Med 2008;132:1830-1834. https://doi.org/10.1043/1543- 2165-132.11.1830
Brastianos PK, Batchelor TT. Primary central nervous system lymphoma: overview of current treatment strategies. Hematol/Oncol Clin North Am 2012;26:897- 916. https://doi.org/10.1016/j.hoc.2012.05.003
Haque S, Law M, Abrey LE, Young RJ. Imaging of lymphoma of the central nervous system, spine, and orbit. Radiol Clin N Am 2008;46:339-361. https://doi. org/10.1016/j.rcl.2008.04.003
Nayak L, Batchelor TT. Recent advances in treatment of primary central nervous system lymphoma. Curr Treat Options in Oncol 2013;14:539-552. https://doi. org/10.1007/s11864-013-0252-6
Perini GF, Campregher PV, Santos FP, Hamerschlak N. Primary central nervous system lymphoma: what a neurologist/neurosurgeon should know? Arq de Neuro-Psiquiatr 2013;71:254-257. https://doi. org/10.1590/0004-282x20130011
Phillips EH, Fox CKP, Cwynarski K. Primary CNS lymphoma. Curr Hematol Malignancy Rep 2014;9:243- 253. https://doi.org/10.1007/s11899-014-0217-2
Rubenstein J, Ferreri AJ, Pittaluga S. Primary lymphoma of the central nervous system: epidemiology, pathology and current approaches to diagnosis, prognosis and treatment. Leukemia&Lymphoma 2008;49:43-51. https://doi.org/10.1080/10428190802311441
Yoon JH, Kang HJ, Kim H, et al. Successful treatment of primary central nervous system lymphoma without irradiation in children: single center experience. J Korean Med Sci 2012;27:1378-1384. https://doi. org/10.3346/jkms.2012.27.11.1378
Gallop Evans E. Primary central nervous system lymphoma. Clin Oncol 2012;24:329-338. https://doi. org/10.1016/j.clon.2012.02.009
Liu HL, Liu T, Ma C, Zhao Y, Zhou Y. Clinical characteristics and prognosis of 20 cases of primary central nervous system lymphoma. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2015;23:111-118. https://doi. org/10.7534/j.issn.1009-2137.2015.01.021
Bathla G, Hegde A. Lymphomatous involvement of the central nervous system. Clin Radiol 2016;71:602-609. https://doi.org/10.1016/j.crad.2016.02.006
Olson JE, Janney CA, Rao RD, et al. The continuing increase in the incidence of primary central nervous system non-Hodgkin lymphoma: a surveillance, epidemiology, and end results analysis. Cancer 2002;95:1504-1510. https://doi.org/10.1002/ cncr.10851
Gasser O, Bihl FK, Wolbers M, et al. HIV patients developing primary CNS lymphoma lack EBV-specific CD4+ T cell function irrespective of absolute CD4+ T cell counts. PLoS Med 2007;4:96. https://doi. org/10.1371/journal.pmed.0040096
Gopal S, Patel MR, Yanik EL, et al. Temporal trends in presentation and survival for HIV-associated lymphoma in the antiretroviral therapy era. J Natl Cancer Inst 2013;105:1221-1229. https://doi.org/10.1093/jnci/ djt158
Beiko J, Suki D, Hess KR, et al. IDH1 mutant malignant astrocytomas are more amenable to surgical resection and have a survival benefit associated with maximal surgical resection. Neuro Oncol 2014;16:81-91. https:// doi.org/10.1093/neuonc/not159
Weller M, Martus P, Roth P, Thiel E, Korfel A, German PSG. Surgery for primary CNS lymphoma? Challenging a paradigm. Neuro Oncol 2012;14:1481-1484. https:// doi.org/10.1093/neuonc/nos159