Combine conference

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Combine conference

• 950529
• NS ???/ Chief CC Shen

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• ?x?, 59 years old female
• Chief complain progressive blurred vision and
  ptosis of left eye for 3 months

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History

1. Progressive blurred vision since Jan. 2006.
2. Ptosis and fixed left eye in Apr. 2006
3. CGMH admission
4. Image studies tumor over left sphenoid sinus
   with cavernous sinus invasion
5. ENT endoscopy surgery on 6th Apr. 2006 --
   necrotic tissue, inflammatory cells and
   lymphocyte
   -- no definite diagnosis gtgt our
   NS OPD
6. NE left CN III, IV, VI and right VI cranial
   nerves were involved.

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• Operation
• 950508
• TSA Malignant lymphoma
• 950518
• Bone marrow aspiration-- Normocellular marrow
  with slight involvement of diffuse B cell
  lymphoma.

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• Image
• Pathology

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Discussion

• Incidence of primary central nervous system
  non-Hodgkin's lymphoma (PCNSL) as 1100000.
• The main increase, however, is taking place since
  the mid-eighties and is due to the increase of
  immunodeficiency and immunosuppression.
• The risk is 2-6 in AIDS patients
• Transplant patients carry a risk of 1-5
• The risk is 1-2 for renal, and 2-7 for cardiac,
  lung or liver transplant recipients.
• Patients with congenital immune deficiency have a
  risk of 4.
• --J Neurooncol. 1999
  Jul43(3)199-201.

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• Non-Hodgkin's lymphoma (NHL) is a rare tumor of
  the skull base.
• Clinicopathologic correlation suggests that
  cranial base and intracranial involvement with
  NHL represents advanced-stage primary sinonasal
  disease.
• Surgical biopsy before definitive treatment is
  recommended.
• Radiation therapy provides local control
  adjuvant chemotherapy after primary radiation
  therapy may be required for recurrent disease.

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• Approximately 10-30 of patients with systemic
  lymphoma may develop secondary CNS involvement.
• Secondary systemic and primary CNS lymphomas have
  similar imaging characteristics.
• Meningeal involvement occurs commonly in
  secondary lymphoma and less frequently in primary
  lymphoma.
• Primary lymphoma presents with supratentorial
  tumor in 75-85 of patients..
  
• 
  -- (Barnard, 1977 Zee, 1996)

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• Resection provides no therapeutic benefit and
  should be reserved for the rare patient with
  neurologic deterioration due to brain herniation.
• Whole-brain radiation therapy (WBRT) alone is
  insufficient for durable tumor control and is
  associated with a high risk of neurotoxicity in
  patients older than age 60.
• Chemotherapy and WBRT together improve tumor
  response rates and survival compared with WBRT
  alone.
• Methotrexate-based multiagent chemotherapy
  without WBRT is associated with similar tumor
  response rates and survival compared with
  regimens that include WBRT
• The risk of neurotoxicity is lower in patients
  treated with chemotherapy alone.
  --J Clin Oncol. 2006 Mar
  1024(8)1281-8.

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