Lymphomas of the central nervous system

Lymphomas are cancers arising from the lymphatic tissue. In the CNS they arise either as a primary disease or secondarily, through metastasis. Primary lymphomas are more common. The worldwide incidence of lymphomas is rising. Patients with immunodeficiency (AIDS) and systemic diseases (systemic lupus erythematosis, rheumatoid arthritis) are at higher risk.

Forms

 * 1) Spinal epidural expansion – manifested by paraparesis and hypoaesthesia.
 * 2) Leptomeningeal carcinomatosis – mening infiltration, simultaneous  paresis of several cranial nerves, most often oculomotor nerves, trigeminal and facial nerves.
 * 3) Expansive foci in brain tissue – most often periventricularly, there may be more foci.

Diagnosis
The basic imaging test is a CT scan of the brain. Lymphoma must be differentiated diagnostically from pseudoependymoma (it is often in contact with the ventricular ependymus or meninges). Pathognomonic is a partial or complete resolution of the lesion after corticoid administration. If CNS lymphoma is suspected, it is necessary to decide whether it is primary or secondary, or to find a primary site. Examination of the lymph nodes, chest X-ray, US abdomen, examination of the testicles, urine and blood, or bone marrow biopsy and eye examination are indicated.

Therapy
The main treatments are radiotherapy and chemotherapy. Surgery does not improve the prognosis and is only relevant for biopsy.

Prognosis
CNS lymphoma is a serious disease with an unfavorable prognosis. Without treatment, the median survival time after diagnosis is 2-3 months. With standard treatment, one-year survival is 47%, five-year 4%. Lymphoma in 75% of patients relapses within fifteen months.

related articles

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 * Meningeomy
 * Intracranial metastases
 * Pituitary adenoma
 * Vestibular schwannoma
 * Cranial base tumors
 * Cerebellar tumors and IV. ventricles in adults