1. Combine conference 950529 NS 張維傑 / Chief CC Shen

2. 游 x 珠, 59 years old female Chief complain: progressive blurred vision and ptosis of left eye for 3 months

3. 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 >> our NS OPD 6. NE: left CN III, IV, VI and right VI cranial nerves were involved.

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

5. Image Pathology

6. Discussion Incidence of primary central nervous system non-Hodgkin's lymphoma (PCNSL) as 1:100000. 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 Jul;43(3):199-201.

7. 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.

8. 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)

9. 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 10;24(8):1281-8.

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