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1、CASEDISCUSSIONWANGLIJUN2008-7-14Case1:Female,66yCase1:PLAINMRICase1:POST-CONTRASTMRICase2:F66YCase2:POST-CONTRASTMRICASE3:M58Y,NHLwasdiagnosed2.5yearsago,nowfeelheadache(2008-1-25)-C+C2008-1-302008-5-15LYMPHOMAPrimarycentralnervoussystemlymphoma(PCNSL)isarareformoflymp
2、haticcancerarisinginthebrain,eye,nerves,spinalfluidsurroundingthebrainandspinalcord,andthecoveringofthebrain,calledduraSecondary:metastasestothenervoussysteminlymphomaaffectingotherorgansPCNSL:EpidemiologyOncerare(~1%),nowbecomingincreasinglymorecommonIncidencehasrisen
3、dramaticallyinpastfewdecades,asPCNSLnowaccountsfor4-7%(16%)ofallnewlydiagnosedprimarybraintumorsIncidencehasrisenintheimmunocompromisedandalsoimmunocompetentpopulationPCNSL:EpidemiologyImmunocompromisedCongenitalcausesofimmunodeficiency1.Wiskott-Aldrichsyndrome2.IgAdef
4、iciency3.X-linkedlymphoproliferativesyndromeacquiredcauses1.HIVinfectionandAIDS2.immunosuppressiveregimenafterorgantransplantationPCNSL:EpidemiologyMedianageofonset55yearsinimmunocompetent,incidenceriseswithageGreatestrisehasoccurredamongtheelderlyMaleismorecommonlysee
5、ncomparetofemale(2:1)DiagnosisHistoryFocalneurologicdeficit(i.e.hemiparesis,aphasia)presentin>50%ofallpatientswithPCNSLAlteredmentalstatus(memoryloss,confusion,etc.)foundin~33%-maybeinsidiousonsetHeadache,nausea(fromincreasedICP)in~33%Maypresentwithnew-onsetseizurein<1
6、0%BlurredvisionifocularlymphomaispresentRadiologicimagingHeadCTdetectsmostlesions(~90%)BrainMRImaydetectlesionsmissedonCTDiagnosisPrimaryCNSlymphomamayarisefromdifferentpartsofthebraindeephemisphericperiventricularwhitematterbeingthemostcommoncorpuscallosum,cerebellum,
7、orbits,andcranialnervesmayalsoharborthetumorHistology:intermediate-tohigh-gradeextranodalnon-Hodgkin'slymphomaofB-celloriginRadiologicImagingTypicalAppearanceinImmunocompetentPatientsUsuallysolitary,non-hemorrhagiclesionindeepwhitematter,nearventriclesLesionisisodenset
8、ohyperdense(70%)surroundingvasogenicedemahomogeneouslyenhancingmassSurroundingedemaistypicallylessprofoundthaninmetas
