Vanishing Tumor of Brain: Administration of Corticosteroids Followed by Disappearance of Primary Central Nervous System Lymphoma

腦部的消失腫瘤：在原發性中樞神經淋巴癌之病人使用皮質類固醇

詹雲凱(Yun-Kai Chan) ； 張丞圭(Cheng-Kuei Chang) ； 蔡承嘉(Cheng-Chia Tsai)

《台灣癌症醫學雜誌》 29卷4期 (2013/10) Pp. 212-220

https://doi.org/10.6323/JoCRP.2013.29.4.7

摘要

我們報告一個右側小腦原發性中樞神經淋巴癌的病例，病人在使用了皮質類固醇十四天之後，腫瘤消失不見了。因為腫瘤消失不見，在立體定位腦部切片中所取出的組織，病理檢查之中並沒有看到任何惡性的細胞。停止了皮質類固醇之後十二天，腫瘤復發了。因此，我們後續安排了下枕部顱骨切除術合併部份移除右側小腦腫瘤，病理檢查顯示是瀰漫性大B細胞淋巴癌。經過確診後，使用了高劑量Methotrexate、Methylprednisolone、Rituximab、以及全腦放射線治療，右側小腦的腫瘤在手術後八個月消失不見。皮質類固醇很常使用在腦部腫瘤的患者，而腫瘤在明確的診斷以及治療（除了皮質類固醇）之前，就自行不見的情況下，稱之為「消失的腫瘤」。這種腫瘤的可能診斷包括淋巴癌、生殖細胞瘤、多發性硬化症、神經系統結節病、局部腦梗塞、以及局部腦炎。我們認為，當我們在腦部的電腦斷層或是磁振造影的影像上懷疑到原發性中樞神經淋巴癌的病灶，在獲得組織以確定病理診斷之前，建議避免使用皮質類固醇。否則，將會導致誤診或延遲診斷。

關鍵字

原發性中樞神經淋巴癌 ； 皮質類固醇

並列摘要

We report a case of primary central nervous system lymphoma (PCNSL) of the right cerebellar hemisphere, which vanished after the use of corticosteroids for 14 days. Because of the disappearance of the tumor, the pathologic examination after stereotactic biopsy revealed no evidence of malignancy. After corticosteroids were stopped, the tumor recurred 12 days later. A suboccipital craniectomy with partial removal of the right cerebellar tumor was then performed. The pathologic examination revealed diffuse large B-cell lymphoma of activated B-cell type. After high-dose Methotrexate, Methylprednisolone, Rituximab, and whole-brain radiation therapy, the right cerebellar PCNSL resolved in 8 months. Corticosteroids are frequently used in patients with intracranial neoplasms. The tumor which spontaneously disappears before definitive diagnosis and treatments (other than corticosteroids) is called a vanishing tumor. The possible diagnoses of vanishing tumors include lymphoma, germinoma, multiple sclerosis, neurosarcoidosis, localized cerebral infarction and focal encephalitis. We suggest that if PCNSL is suspected on non-enhanced and contrast-enhanced cranial CT scanning or MRI, we should not use corticosteroid until tissue has been obtained for diagnosis. Otherwise, it may lead to misdiagnosis or a delayed diagnosis.

並列關鍵字

primary central nervous system lymphoma (PCNSL) ； corticosteroid