Background Central nervous system lymphoma (CNSL) can be divided into primary central nervous system lymphoma (PCNSL) and secondary nervous system lymphoma (SCNSL). The incidence of CNSL is increasing in recent years, yet there is still a lack of analysis of their unique clinical characteristics.
Objective To evaluate the clinical characteristics of PCNSL and SCNSL by previous medical records, so as to improve understandings of PCNSL and SCNSL.
Methods From January 2015 to December 2020, 29 cases with PCNSL and 16 cases with SCNSL were diagnosed in the department of hematology of Northern Theater General Hospital, their clinical manifestations and diagnostic characteristics were analyzed.
Results CNSL accounted for 9.76% of 461 cases of lymphoma treated in our hospital during this period. There were significant differences in group B symptoms, initial LDH level, intracranial focus location, extramedullary infiltration and cell source between the two groups (P<0.05), however, no significant difference was found in sex, age, highest LDH level, origin of germinal center, CNS-IPI score, IELSG score, cerebrospinal fluid index or therapeutic effect (P>0.05). Pathological results showed that all patients in PCNSL group had B-cell-derived lymphoma. There were 26 cases (89.7%) with elevated initial LDH, 15 cases (51.7%) were simple brain parenchyma type, and 14 cases (48.3%) were meningeal and cerebral parenchyma coexisting type. In SCNSL group, patients with T cells or B cells showed similar proportion. The initial LDH increased in 8 patients (50.0%), simple meningeal type was found in 5 cases (31.3%), and 9 cases (56.2%) were meningeal and brain parenchyma type. The total response rate of PCNSL was higher than that of SCNSL (62.1% vs 43.7%).
Conclusion Most of the patients with PCNSL are B cells with increasing initial LDH. The parenchyma lesions can be detected by imaging, half of them are involved in the meninges, and the cerebrospinal fluid protein increases. SCNSL can be derived from T cells and B cells, the initial LDH of half of the patients increases, so does the cerebrospinal fluid protein. More than half of the parenchyma lesions are detected by imaging, and the total response rate of treatment is lower than that of PCNSL.
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