骨原发性淋巴瘤继发中枢神经系统浸润1例病例报告及文献复习

目的:探讨骨原发性淋巴瘤(primary bone lymphoma,PBL)继发中枢神经系统(CNS)浸润的主要临床特点、诊断及治疗。方法:分析我科收治的1例弥漫大B细胞性PBL继发CNS浸润患者的临床表现及相关检查结果,治疗方法,并复习相关文献。结果:本例患者为老年男性,主要临床表现为骨痛,经PET/CT、骨髓象、骨组织活检、免疫组化及流式细胞学等检查确诊为弥漫大B细胞性PBL。行R-CHOP化疗方案治疗,化疗后症状缓解,但出现CNS浸润。先后给予6次鞘内注射(Ara-C、MTX、DEX),并同时2次大剂量的甲氨蝶呤(HD-MTX)系统性化疗,10次腰骶部放疗后,症状缓解,但3个月后因肺部感染死亡。结论:本例患者以骨痛为首发表现,PET/CT结合MRI示多发骨损害,经骨髓象及活检、免疫组化染色,流式细胞学检查明确诊断,对PBL应重视CNS侵犯及预防。

One case report of primary bone lymphoma with secondary central nervous system involvement with literature review

Objective： To investigate the chief clinical symptoms, diagnosis and treatment of primary bone lymphoma （PBL） with central nervous system （CNS） involvement. Methods ： A case with large B-cell PBL with CNS involvement was reported and discussed, focusing on the clinical presentation, results of relevant examination and treatment strategy. Rele- vant literatures were reviewed and summarized. Results ： An old male patient with bony pain was diagnosed as diffused large B-cell lymphoma PBL by PET/CT, myelogram, bone biopsy, immunohistochemistry examination and flow cytometry. The R-CHOP chemotherapy regimen was given and improvement in clinical symptoms was observed, however, malignant infil- tration in CNS was detected during the treatment. Subsequently, the patient had received intrathecal injection （cytarabine, methotrexate, dexamethasone） and systemic intravenous high dose methotrexate （HD-MTX） treatment as well as lumbosa- eral radiotherapy, he achieved remission in clinical symptoms, but died of pulmonary infection after three months. Conclu- sions： With the initial clinical manifestation of bony pain, the case was diagnosed definitely by PET/CT, myelogram, bone biopsy, immunohistochemistry examination and flow cytometry. For PBL, detection and prophylaxis of CNS invasion is very important.