抄録
Two cases of malignant lymphoma with skin and secondary central nervous system (CNS) involvement were reported.
Case 1: A 69-year-old male presented with the skin, paranasal cavity, laryngeal and intrathoracic involvement by B cell lympboma (diffuse medium cell type). He also complained of paraesthesia on the left leg. Although these lesions almost disappeared after VEPA therapy, the patient complained of clounding of conciousness and poor memory two months later. Examination revealed leptomeningeal involvement and epidural spinal cord compression. Lumbar puncture disclosed numerous atypical cells which were positive for CD20. The patient died of pneumonia after few months, although these atypical cells in the spinal fluid disappeared after intrathecal chemo-therapy.
Case 2: A 61-year-old male developed cutaneous T cell lymphoma (diffuse medium cell type) without any other symptoms. The skin lesions disappeared after VEPA therapy. He suddenly developed clouding of conciousness and poor memory after one year of remission. CT scans showed an intracerebral mass. In spite of whole brain irradiation and both systemic and intrathecal chemotherapy, the tumor did not decrease in size and the patient died of pneumonia after 1.5 years.
In the literature, CNS involvement developed 5-10% of adult malignant lymphoma. The risk factors for secondary CNS involvement were considered to be stage IV diseases, B symptoms, diffuse large cell or mixed cell type, involvement of the testis, peripheral blood, nasal/paranasal sinuses and bone marrow. Thus, the case 1 might have been given a prophylactic treatment, since he had several signs described above.
