馬尾生検が診断に有用であった髄膜播種性の悪性リンパ腫の1例
症例は49歳男性である．歩行障害を主訴に来院された．全身倦怠感，両下腿の異常感覚に加え，両下肢筋力低下が亜急性に進行し，歩行不能になった．腰椎MRIで馬尾全体が著明に腫大し，びまん性に造影効果をともなっていた．原因を精査していたところ急激に膀胱直腸障害，意識障害および複視が出現した．早急に馬尾生検を施行し，悪性リンパ腫の診断にいたった．化学療法と放射線療法を組み合わせ，症状は著明に改善した．治療後10ヵ月の時点で，下腿の不全麻痺，振動覚低下および異常感覚が残存するが，再発はなくその他の機能は良好でありすでに社会復帰している．髄液検査，馬尾生検が迅速な診断と治療につながり有用であった．...
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| Published in | 臨床神経学 Vol. 53; no. 10; pp. 803 - 808 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2013
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.53.803 |
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| Abstract | 症例は49歳男性である．歩行障害を主訴に来院された．全身倦怠感，両下腿の異常感覚に加え，両下肢筋力低下が亜急性に進行し，歩行不能になった．腰椎MRIで馬尾全体が著明に腫大し，びまん性に造影効果をともなっていた．原因を精査していたところ急激に膀胱直腸障害，意識障害および複視が出現した．早急に馬尾生検を施行し，悪性リンパ腫の診断にいたった．化学療法と放射線療法を組み合わせ，症状は著明に改善した．治療後10ヵ月の時点で，下腿の不全麻痺，振動覚低下および異常感覚が残存するが，再発はなくその他の機能は良好でありすでに社会復帰している．髄液検査，馬尾生検が迅速な診断と治療につながり有用であった． |
|---|---|
| AbstractList | 症例は49歳男性である．歩行障害を主訴に来院された．全身倦怠感，両下腿の異常感覚に加え，両下肢筋力低下が亜急性に進行し，歩行不能になった．腰椎MRIで馬尾全体が著明に腫大し，びまん性に造影効果をともなっていた．原因を精査していたところ急激に膀胱直腸障害，意識障害および複視が出現した．早急に馬尾生検を施行し，悪性リンパ腫の診断にいたった．化学療法と放射線療法を組み合わせ，症状は著明に改善した．治療後10ヵ月の時点で，下腿の不全麻痺，振動覚低下および異常感覚が残存するが，再発はなくその他の機能は良好でありすでに社会復帰している．髄液検査，馬尾生検が迅速な診断と治療につながり有用であった． |
| Author | 安倍, 邦子 中嶋, 秀樹 山口, 将 本村, 政勝 加藤, 丈晴 |
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| References | 18) Guha-Thakurta N, Damek D, Pollack C, et al. Intravenous methotrexate as initial treatment for primary central nervous system lymphoma: response to therapy and quality of life of patients. J Neurooncol 1999;43:259-268. 3) Ampil F, Polin R, Nanda A. Cauda equina compression by malignant lymphoma: long-term survival following multimodality therapy. Leuk Lymphoma 2001;41:417-420. 23) O’Brien PC, Roos DE, Pratt G, et al. Combined-modality therapy for primary central nervous system lymphoma: long-term data from a Phase II multicenter study (Trans-Tasman Radiation Oncology Group). Int J Radiat Oncol Biol Phys 2006;64:408-413. 2) Hopkins TJ, Raducun V, Sioutos N, et al. Lumbar lymphoma presenting as psoas abscess/epidural mass with acute cauda equina syndrome. A case report. Spine 1993;18:774-778. 21) Herrlinger U, Küker W, Uhl M, et al. NOA-03 trial of high-dose methotrexate in primary central nervous system lymphoma: final report. Ann Neurol 2005;57:843-847. 8) Iwasaki M, Hida K, Yano S, et al. Primary cauda equina lymphoma treated with high-dose methotrexate. Neurol Med Chir (Tokyo) 2012;52:679-683. 12) Balmaceda C, Gaynor JJ, Sun M, et al. Leptomeningeal tumor in primary central nervous system lymphoma: recognition, significance, and implications. Ann Neurol 1995;38:202-209. 9) Shah GD, Yahalom J, Correa DD, et al. Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol 2007;25:4730-4735. 6) Tahiri L, Benbouazza K, Amine B, et al. Primary non-Hodgkin’s lymphoma presenting as radicular syndrome: report of two cases. Rheumatol Int 2009;30:113-117. 26) Le EN, Gerstenblith MR, Gelber AC, et al. The use of blind skin biopsy in the diagnosis of intravascular B-cell lymphoma. J Am Acad Dermatol 2008;59:148-151. 20) Pels H, Schnidt-Wolf IG, Glasmacher A, et al. Primary central nervous system lymphoma: results of a pilot and phase II study of systemic and intraventricular chemotherapy with deferred radiotherapy. J Clin Oncol 2003;24:4489-4495. 10) The Non-Hodgkin’s Lymphoma Classification Project: A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin’s lymphoma. Blood 1997;89:3909-3918. 27) Murase T, Nakamura S, Kawauchi K, et al. An Asian variant of intravascular large B-cell lymphoma: clinical, pathological and cytogenetic approaches to diffuse large B-cell lymphoma associated with haemophagocytic syndrome. Br J Haematol 2000;111:826-834. 15) Wan JH, Trainor KJ, Brisco MJ, et al. Monoclonality in B cell lymphoma detected in paraffin wax embedded sections using the polymerase chain reaction. J Clin Pathol 1990;43:888-890. 1) Mauney M, Sciotto CG. Primary malignant lymphoma of the cauda equina. Am J Surg Pathol 1983;7:185-190. 17) Abrey LE, Yahalom J, DeAngelis LM. Treatment for primary CNS lymphoma: the next step. J Clin Oncol 2000;18:3144-3150. 25) 島田和之，直江知樹，中村栄男ら．血管内大細胞型B細胞リンパ腫診療の最近の進歩と展望．臨床血液 2010;51:447-453. 11) Miller DC, Hochberg FH, Harris NL, et al. Pathology with clinical correlations of primary central nervous system non-Hodgkin’s lymphoma: The Massachusetts General Hospital experience 1958-1989. Cancer 1994;74:1383-1397. 16) Diss TC, Liu HX, Du MQ, et al. Improvement to B cell clonality analysis using PCR amplification of immunoglobulin light chain genes. J Clin Pathol 2002;55:98-101. 22) Glass J, Gruber ML, Cher L, et al. Preirradiation methotrexate chemotherapy of primary central nervous system lymphoma: long-term outcome. J Neurosurg 1994;81:188-195. 24) Abrey LE, DeAngelis LM, Yahalom J. Long-term survival in primary CNS lymphoma. J Clin Oncol 1998;16:859-863. 14) Scott BJ, Douglas VC, Tihan T, et al. A systematic approach to the diagnosis of suspected central nervous system lymphoma. JAMA Neurol 2013:70;311-319. 5) Tajima Y, Sudo K, Matumoto A. Malignant lymphoma originating in the cauda equina mimicking the inflammatory polyradiculoneuropathy. Intern Med 2007;46:1029-1032. 7) Ogilvie C, Lund K, McKay P, et al. Extranodal or primary CNS DLBC lymphoma? EJC Supplements 2010;8:19. 4) 横須賀公章，神保幸太郎，高宮啓彰ら．馬尾神経に原発した悪性リンパ腫の一例（会）．整外と災外 2003;52:442. 13) Batchelor TT, Loeffler JS. Primary CNS lymphoma. J Clin Oncol 2006;24:1281-1288. 19) Batchelor T, Carson K, O’Neill A, et al. Treatment of primary CNS lymphoma with methotrexate and deferred radiotherapy: a report of NABTT 96-07. J Clin Oncol 2003;21:1044-1049. |
| References_xml | – reference: 7) Ogilvie C, Lund K, McKay P, et al. Extranodal or primary CNS DLBC lymphoma? EJC Supplements 2010;8:19. – reference: 25) 島田和之，直江知樹，中村栄男ら．血管内大細胞型B細胞リンパ腫診療の最近の進歩と展望．臨床血液 2010;51:447-453. – reference: 6) Tahiri L, Benbouazza K, Amine B, et al. Primary non-Hodgkin’s lymphoma presenting as radicular syndrome: report of two cases. Rheumatol Int 2009;30:113-117. – reference: 9) Shah GD, Yahalom J, Correa DD, et al. Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol 2007;25:4730-4735. – reference: 12) Balmaceda C, Gaynor JJ, Sun M, et al. Leptomeningeal tumor in primary central nervous system lymphoma: recognition, significance, and implications. Ann Neurol 1995;38:202-209. – reference: 10) The Non-Hodgkin’s Lymphoma Classification Project: A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin’s lymphoma. Blood 1997;89:3909-3918. – reference: 14) Scott BJ, Douglas VC, Tihan T, et al. A systematic approach to the diagnosis of suspected central nervous system lymphoma. JAMA Neurol 2013:70;311-319. – reference: 11) Miller DC, Hochberg FH, Harris NL, et al. Pathology with clinical correlations of primary central nervous system non-Hodgkin’s lymphoma: The Massachusetts General Hospital experience 1958-1989. Cancer 1994;74:1383-1397. – reference: 18) Guha-Thakurta N, Damek D, Pollack C, et al. Intravenous methotrexate as initial treatment for primary central nervous system lymphoma: response to therapy and quality of life of patients. J Neurooncol 1999;43:259-268. – reference: 22) Glass J, Gruber ML, Cher L, et al. Preirradiation methotrexate chemotherapy of primary central nervous system lymphoma: long-term outcome. J Neurosurg 1994;81:188-195. – reference: 5) Tajima Y, Sudo K, Matumoto A. Malignant lymphoma originating in the cauda equina mimicking the inflammatory polyradiculoneuropathy. Intern Med 2007;46:1029-1032. – reference: 8) Iwasaki M, Hida K, Yano S, et al. Primary cauda equina lymphoma treated with high-dose methotrexate. Neurol Med Chir (Tokyo) 2012;52:679-683. – reference: 24) Abrey LE, DeAngelis LM, Yahalom J. Long-term survival in primary CNS lymphoma. J Clin Oncol 1998;16:859-863. – reference: 13) Batchelor TT, Loeffler JS. Primary CNS lymphoma. J Clin Oncol 2006;24:1281-1288. – reference: 19) Batchelor T, Carson K, O’Neill A, et al. Treatment of primary CNS lymphoma with methotrexate and deferred radiotherapy: a report of NABTT 96-07. J Clin Oncol 2003;21:1044-1049. – reference: 15) Wan JH, Trainor KJ, Brisco MJ, et al. Monoclonality in B cell lymphoma detected in paraffin wax embedded sections using the polymerase chain reaction. J Clin Pathol 1990;43:888-890. – reference: 21) Herrlinger U, Küker W, Uhl M, et al. NOA-03 trial of high-dose methotrexate in primary central nervous system lymphoma: final report. Ann Neurol 2005;57:843-847. – reference: 27) Murase T, Nakamura S, Kawauchi K, et al. An Asian variant of intravascular large B-cell lymphoma: clinical, pathological and cytogenetic approaches to diffuse large B-cell lymphoma associated with haemophagocytic syndrome. Br J Haematol 2000;111:826-834. – reference: 2) Hopkins TJ, Raducun V, Sioutos N, et al. Lumbar lymphoma presenting as psoas abscess/epidural mass with acute cauda equina syndrome. A case report. Spine 1993;18:774-778. – reference: 17) Abrey LE, Yahalom J, DeAngelis LM. Treatment for primary CNS lymphoma: the next step. J Clin Oncol 2000;18:3144-3150. – reference: 3) Ampil F, Polin R, Nanda A. Cauda equina compression by malignant lymphoma: long-term survival following multimodality therapy. Leuk Lymphoma 2001;41:417-420. – reference: 4) 横須賀公章，神保幸太郎，高宮啓彰ら．馬尾神経に原発した悪性リンパ腫の一例（会）．整外と災外 2003;52:442. – reference: 16) Diss TC, Liu HX, Du MQ, et al. Improvement to B cell clonality analysis using PCR amplification of immunoglobulin light chain genes. J Clin Pathol 2002;55:98-101. – reference: 23) O’Brien PC, Roos DE, Pratt G, et al. Combined-modality therapy for primary central nervous system lymphoma: long-term data from a Phase II multicenter study (Trans-Tasman Radiation Oncology Group). Int J Radiat Oncol Biol Phys 2006;64:408-413. – reference: 1) Mauney M, Sciotto CG. Primary malignant lymphoma of the cauda equina. Am J Surg Pathol 1983;7:185-190. – reference: 26) Le EN, Gerstenblith MR, Gelber AC, et al. The use of blind skin biopsy in the diagnosis of intravascular B-cell lymphoma. J Am Acad Dermatol 2008;59:148-151. – reference: 20) Pels H, Schnidt-Wolf IG, Glasmacher A, et al. Primary central nervous system lymphoma: results of a pilot and phase II study of systemic and intraventricular chemotherapy with deferred radiotherapy. J Clin Oncol 2003;24:4489-4495. |
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| Title | 馬尾生検が診断に有用であった髄膜播種性の悪性リンパ腫の1例 |
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