Work-up and management of a high-risk patient with primary central nervous system lymphoma
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摘要
Primary central nervous system lymphoma(PCNSL) is a rare disorder that, in 95% of cases, represents diffuse large B-cell lymphoma. As such, making an accurate diagnosis is important. At present, stereotactic-guided biopsy is a recognized method of choice for tissue analysis. However, the diagnostic work-up for high-risk patients is determined by their performance status. Here,we report a case of PCNSL in a high-risk patient, for whom diagnosis was established by cerebrospinal fluid cytology and flow cytometry, which significantly shortened a diagnostic work-up period and allowed for the immediate treatment of the patient.
Primary central nervous system lymphoma(PCNSL) is a rare disorder that, in 95% of cases, represents diffuse large B-cell lymphoma. As such, making an accurate diagnosis is important. At present, stereotactic-guided biopsy is a recognized method of choice for tissue analysis. However, the diagnostic work-up for high-risk patients is determined by their performance status. Here,we report a case of PCNSL in a high-risk patient, for whom diagnosis was established by cerebrospinal fluid cytology and flow cytometry, which significantly shortened a diagnostic work-up period and allowed for the immediate treatment of the patient.
Primary central nervous system lymphoma(PCNSL) is a rare disorder that, in 95% of cases, represents diffuse large B-cell lymphoma. As such, making an accurate diagnosis is important. At present, stereotactic-guided biopsy is a recognized method of choice for tissue analysis. However, the diagnostic work-up for high-risk patients is determined by their performance status. Here,we report a case of PCNSL in a high-risk patient, for whom diagnosis was established by cerebrospinal fluid cytology and flow cytometry, which significantly shortened a diagnostic work-up period and allowed for the immediate treatment of the patient.
引文
1.Ferreri AJM.How I treat primary CNS lymphoma.Blood.2011;118:510-22.
2.Villano JL,Koshy M,Shaikh H,Dolecek TA,Mc Carthy BJ.Age,gender,and racial differences in incidence and survival in primary CNS lymphoma.Br J Cancer.2011;105:1414-8.
3.Camilleri-Bro?t S,Martin A,Moreau A,Angonin R,Hénin D,Gontier MF,et al.Primary central nervous system lymphomas in72 immunocompetent patients:pathologic findings and clinical correlations.Groupe Ouest Est d'étude des Leucénies et Autres Maladies du Sang(GOELAMS).Am J Clin Pathol.1998;110:607-12.
4.Campo E,Swerdlow SH,Harris NL,Pileri S,Stein H,Jaffe ES.The2008 WHO classification of lymphoid neoplasms and beyond:evolving concepts and practical applications.Blood.2011;117:5019-32.
5.Chen D,Gu W,Li W,Liu X,Yang X.Primary diffuse large B-cell lymphoma of the central nervous system:a case report and literature review.Oncol Lett.2016;11:3085-90.
6.Ferreri AJM,Marturano E.Primary CNS lymphoma.Best Pract Res Clin Haematol.2012;25:119-30.
7.Mrugala MM,Rubenstein JL,Ponzoni M,Batchelor TT.Insights into the biology of primary central nervous system lymphoma.Curr Oncol Rep.2009;11:73-80.
8.Bessell EM,Hoang-Xuan K,Ferreri AJM,Reni M.Primary central nervous system lymphoma:biological aspects and controversies in management.Eur J Cancer.2007;43:1141-52.
9.Ferreri AJM,Reni M,Foppoli M,Martelli M,Pangalis GA,Frezzato M,et al.High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNSlymphoma:a randomised phase 2 trial.Lancet.2009;374:1512-20.
10.Ferreri AJ,Cwynarski K,Pulczynski E,Ponzoni M,Deckert M,Politi LS,et al.Chemoimmunotherapy with methotrexate,cytarabine,thiotepa,and rituximab(MATRix regimen)in patients with primary CNS lymphoma:results of the first randomisation of the International Extranodal Lymphoma Study Group-32(IELSG32)phase 2 trial.Lancet Haematol.2016;3:e217-27.
11.Fischer L,Jahnke K,Martus P,Weller M,Thiel E,Korfel A.The diagnostic value of cerebrospinal fluid pleocytosis and protein in the detection of lymphomatous meningitis in primary central nervous system lymphomas.Haematologica.2006;91:429-30.
12.Bromberg JEC,Breems DA,Kraan J,Bikker G,van der Holt B,Smitt PS,et al.CSF flow cytometry greatly improves diagnostic accuracy in CNS hematologic malignancies.Neurology.2007;68:1674-9.
13.Canovi S,Campioli D.Accuracy of flow cytometry and cytomorphology for the diagnosis of meningeal involvement in lymphoid neoplasms:a systematic review.Diagn Cytopathol.2016;44:841-56.
2.Villano JL,Koshy M,Shaikh H,Dolecek TA,Mc Carthy BJ.Age,gender,and racial differences in incidence and survival in primary CNS lymphoma.Br J Cancer.2011;105:1414-8.
3.Camilleri-Bro?t S,Martin A,Moreau A,Angonin R,Hénin D,Gontier MF,et al.Primary central nervous system lymphomas in72 immunocompetent patients:pathologic findings and clinical correlations.Groupe Ouest Est d'étude des Leucénies et Autres Maladies du Sang(GOELAMS).Am J Clin Pathol.1998;110:607-12.
4.Campo E,Swerdlow SH,Harris NL,Pileri S,Stein H,Jaffe ES.The2008 WHO classification of lymphoid neoplasms and beyond:evolving concepts and practical applications.Blood.2011;117:5019-32.
5.Chen D,Gu W,Li W,Liu X,Yang X.Primary diffuse large B-cell lymphoma of the central nervous system:a case report and literature review.Oncol Lett.2016;11:3085-90.
6.Ferreri AJM,Marturano E.Primary CNS lymphoma.Best Pract Res Clin Haematol.2012;25:119-30.
7.Mrugala MM,Rubenstein JL,Ponzoni M,Batchelor TT.Insights into the biology of primary central nervous system lymphoma.Curr Oncol Rep.2009;11:73-80.
8.Bessell EM,Hoang-Xuan K,Ferreri AJM,Reni M.Primary central nervous system lymphoma:biological aspects and controversies in management.Eur J Cancer.2007;43:1141-52.
9.Ferreri AJM,Reni M,Foppoli M,Martelli M,Pangalis GA,Frezzato M,et al.High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNSlymphoma:a randomised phase 2 trial.Lancet.2009;374:1512-20.
10.Ferreri AJ,Cwynarski K,Pulczynski E,Ponzoni M,Deckert M,Politi LS,et al.Chemoimmunotherapy with methotrexate,cytarabine,thiotepa,and rituximab(MATRix regimen)in patients with primary CNS lymphoma:results of the first randomisation of the International Extranodal Lymphoma Study Group-32(IELSG32)phase 2 trial.Lancet Haematol.2016;3:e217-27.
11.Fischer L,Jahnke K,Martus P,Weller M,Thiel E,Korfel A.The diagnostic value of cerebrospinal fluid pleocytosis and protein in the detection of lymphomatous meningitis in primary central nervous system lymphomas.Haematologica.2006;91:429-30.
12.Bromberg JEC,Breems DA,Kraan J,Bikker G,van der Holt B,Smitt PS,et al.CSF flow cytometry greatly improves diagnostic accuracy in CNS hematologic malignancies.Neurology.2007;68:1674-9.
13.Canovi S,Campioli D.Accuracy of flow cytometry and cytomorphology for the diagnosis of meningeal involvement in lymphoid neoplasms:a systematic review.Diagn Cytopathol.2016;44:841-56.