Primary non-Hodgkin's lymphomas of the CNS

Abstract

This paper reports on 10 patients (4 male, 6 female) with primary non‐Hodgkin's lymphomas of the brain (CNS‐NHL — mean age 46.8 years, mean postdiagnostic survival 10 months). Pathological CSF (cerebrospinal fluid) was found in all 8 patients examined (positive cytology in 7/8 cases). Solitary tumors, diffuse periventricular infiltration or diffuse cerebral infiltration were demonstrated in cerebral computer‐assisted tomography (CAT). Angiographical findings were unspecific. The histologic subtypes were lymphoplasmocytoid immunocytoma (4), unclassified low grade (1), centroblastic (1), B‐immunoblastic (1), T‐immunoblastic (1), lymphoblastic convoluted T‐cell type (1), unclassified high grade (1) NHL. Patients who had received radiotherapy (+/— surgery) in this group had a mean survival of 15.66 months (σ = 7.63). In addition, an overview of 83 well‐documented, cases of the literature tries to characterize main histological and topographical distributions, histology‐, patient's age‐, and therapy‐related survival. Patients with primary CNS‐NHL have a 5‐year survival expectancy of 30% compared with 2.3% in secondary CNS‐manifestations of systemic non‐Hodgkin's lymphomas. In this report, the beneficial effect of radiotherapy (mean survival 30.3 months) compared to surgery or symptomatic treatment (3.6 or 3.3 months) could be confirmed. It is concluded that primary CNS‐NHL frequently present with atypical neuropsychiatric syndromes; diagnosis should be established preferentially with CAT and CSF‐examinations or stereotactic biopsies, whereas open surgery should be avoided. An approach to exact classification should be attempted, as survival is clearly related to histological subtypes.