Hodgkin's Lymphoma and Paraneoplastic Phenomena in the Central Nervous System: A Case Report and Review of the Literature
Hodgkin's Lymphoma and Paraneoplastic Phenomena in the Central Nervous System: A Case Report and Review of the Literature
复制标题
霍奇金淋巴瘤和中枢神经系统副肿瘤现象：一例报告及文献复习
作者：
M. Vetter;A. Tzankov;A. Engert;M. Mehling;R. Herrmann;C. Rochlitz
一名 25 岁男性患者就诊于我们的耳鼻喉诊所，有恶心、呕吐、头痛、眩晕病史，并且在过去 3 个月内体重减轻了 5 公斤。临床检查时发现颈部淋巴结肿大。淋巴结活检显示结节性淋巴细胞为主的霍奇金淋巴瘤（NLPHL，结节性副肉芽肿）。由于神经系统症状，进行了脑 MRI 扫描，结果显示颞叶血管周围、双侧、造影剂增强病变，提示脑血管炎。脑脊液分析显示单核细胞数量增加，但没有迹象表明存在嗜神经病毒或细菌感染。脑电图显示左侧颞部癫痫病灶，并开始抗癫痫治疗。 NLPHL接受2个周期的ABVD化疗和20Gy受累野放疗。在化疗前 1 周开始针对假定的副肿瘤性神经系统表现进行类固醇治疗（强的松 100 mg q.d.），并导致主诉迅速消失。由于在 ABVD 化疗 3 周和类固醇治疗 4 周后恶心和眩晕再次发作，进行了后续脑 MRI 和脑电图检查，结果显示“血管炎”变化完全消失，没有其他病理发现。治疗五个月后，患者没有出现神经系统症状，PET-CT 显示完全缓解。该病例是新诊断 NLPHL 患者副肿瘤性中枢神经系统 (CNS) 受累的独特例子。我们对霍奇金淋巴瘤副肿瘤中枢神经系统症状的文献进行了综述。
A 25-year-old male patient presented to our Ear, Nose and Throat clinic with a history of nausea, vomiting, headache, vertigo and weight loss of 5 kg over the preceding 3 months. An enlarged cervical lymph node was detected at clinical examination. Lymph node biopsy showed nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL, nodular paragranuloma). Because of the neurological symptoms a cerebral MRI scan was performed and revealed an intense perivascular, bilateral, contrast-medium enhancing lesion of the temporal lobes suggestive of cerebral vasculitis. Cerebrospinal fluid analysis showed an increased number of mononuclear cells, but there was no indication for neurotropic viral or bacterial infections. EEG revealed a left temporal epileptic focus, and anti-epileptic therapy was initiated. NLPHL was treated with 2 cycles of ABVD chemotherapy and 20 Gy involved-field radiotherapy. Steroid therapy (prednisone 100 mg q.d.) for the presumed paraneoplastic neurological manifestation was started 1 week before chemotherapy and led to the rapid disappearance of complaints. Because of renewed onset of nausea and vertigo after 3 weeks of treatment with ABVD chemotherapy and 4 weeks of treatment with steroids, a follow-up brain MRI and EEG were performed and demonstrated complete disappearance of the ‘vasculitic’ changes without additional pathologic findings. Five months after therapy, the patient is without neurological symptoms and a PET-CT showed a complete remission. This case is a unique example of paraneoplastic central nervous system (CNS) involvement in a patient with newly diagnosed NLPHL. We present a review of the literature on paraneoplastic CNS symptoms in Hodgkin’s lymphoma.