Primary Gehirmlymphome

Primary brain lymphomas arising in the nervous tissue and are usually B-cell tumors. The diagnosis requires imaging and sometimes a cerebrospinal fluid (incl. Epstein-Barr virus titer) or a brain biopsy. The treatment includes corticosteroids, chemotherapy and radiotherapy.

The incidence of primary brain lymphoma is increasing, v. a. in immunocompromised patients and the elderly. Lymphomas tend to diffuse infiltration of the brain, often as a multicenter lesions near the ventricles, but they can also occur as circumscribed intracranial mass lesion. The lymphomas can also occur in the meninges, the uvea or Glaskörperinfiltrat. Most are B-cell tumors, often from immunoblastic type. The Epstein-Barr virus may contribute to the development of lymphomas in immunocompromised patients. Most patients do not develop systemic lymphoma in the course.

Primary brain lymphomas arising in the nervous tissue and are usually B-cell tumors. The diagnosis requires imaging and sometimes a cerebrospinal fluid (incl. Epstein-Barr virus titer) or a brain biopsy. The treatment includes corticosteroids, chemotherapy and radiotherapy. The incidence of primary brain lymphoma is increasing, v. a. in immunocompromised patients and the elderly. Lymphomas tend to diffuse infiltration of the brain, often as a multicenter lesions near the ventricles, but they can also occur as circumscribed intracranial mass lesion. The lymphomas can also occur in the meninges, the uvea or Glaskörperinfiltrat. Most are B-cell tumors, often from immunoblastic type. The Epstein-Barr virus may contribute to the development of lymphomas in immunocompromised patients. Most patients do not develop systemic lymphoma in the course. Diagnosis MRI Sometimes cerebrospinal fluid or biopsy, MRI may be diagnostic conductive. However, the MRT sometimes can not distinguish between lymphoma and cerebral toxoplasmosis, which is common in AIDS patients. If meningeal signs are present, the liquor is examined; it may contain lymphoma cells. In immunocompromised patients, DNA of the Epstein-Barr virus can be detected in the cerebrospinal fluid. If the liquor contains no lymphoma cells or Epstein-Barr virus DNA, a guided needle or open biopsy is needed. Since the initial lymphoma is highly sensitive to corticosteroid treatment, the application of these drugs can lead just before the biopsy to the disappearance of the lesion and to a false-negative biopsy. Treatment Corticosteroids chemotherapy radiotherapy Most primary brain lymphomas are difficult to treat curative because they infiltrate the brain diffusely. Usually first corticosteroids lead to a rapid improvement. Many chemotherapy regimen, v. a. those with methotrexate (applied as a high-dose i.v. infusions), are effective; with methotrexate, the average survival time can be close to 4 years. Methotrexate may also be administered intrathecally, usually through a under the scalp (subgaleal) implanted catheter system with connection to the ventricular system (Ommaya reservoir). The substance is sometimes after induction of general anesthesia and administration of 25% mannitol i.v. for opening the blood-brain barrier, infused into the carotid artery. To the chemotherapy regimen, a radiation therapy may be followed is usually done this for 12-16 weeks, but it is sometimes delayed also to recurrence of the tumor. The delay helps to reduce the toxicity by the radiation.

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