侵袭性 b 细胞淋巴瘤伴转移性脊髓压迫:治疗病人而非疾病。

IF 2 4区 医学 Q3 ONCOLOGY Oncology Research and Treatment Pub Date : 2024-01-01 Epub Date: 2024-03-01 DOI:10.1159/000538104
Leonid L Yavorkovsky
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引用次数: 0

摘要

简介恶性脊髓压迫症(mSCC)的治疗是一项艰巨的任务。恶性脊髓脊膜压迫症的主要挑战包括各种表现和不可预测的结果,以及不加区分的治疗建议。由于脊髓脊膜膨出的紧迫性和潜在的破坏性健康后果,脊髓脊膜膨出是一种令人不安的情绪体验,其管理可能会采取冲动而非理性的方法。当 mSCC 由具有蛋白属性的恶性淋巴瘤引起时,治疗策略尤其成问题:病例报告:一名 68 岁的女性因全身疼痛和体重减轻前来就诊。影像学检查显示,大部分病变累及淋巴结、脾脏、内脏器官、肌肉组织、骨髓和骨骼(包括椎骨),并延伸至椎管。胸壁肿块活检显示为高级别弥漫大 B 细胞淋巴瘤。脊柱磁共振成像(MRI)显示,胸椎和腰椎的弥漫性骨髓被肿瘤取代,脊髓受到压迫。医生建议立即使用皮质类固醇激素和免疫化学疗法(ICT)进行治疗,但患者选择寻求第二意见。在接受了两次放射治疗(RT)后,患者的全身状况迅速恶化,她被送往医院接受全身性的 ICT 治疗。尽管接受了治疗,她的病情仍在继续恶化,并在就诊三周后去世:本病例表明,在评估和治疗侵袭性非霍奇金淋巴瘤(LSSC)引起的 mSCC 方面存在一些迄今尚未解决的难题。该病例探讨了磁共振成像在不常见的临床情况中的作用。该病例还揭示了与正确处理 LSCC 相关的一些伦理问题。
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Aggressive B-Cell Lymphoma with Metastatic Spinal Cord Compression: Treat the Patient, Not the Disease.

Introduction: The management of metastatic spinal cord compression (mSCC) is a demanding task. The main challenges of mSCC include various manifestations and unpredictable outcomes with indiscriminate treatment recommendations. Because of attendant urgency with potentially devastating health consequences, the SCC is an emotionally disturbing experience whose management could take an impulsive rather than rational approach. The treatment strategy is particularly problematic when mSCC is caused by a malignant lymphoma with its protean attributes.

Case report: A 68-year-old female presented with generalized body pain and weight loss. Imaging studies revealed a vast bulk of the disease involving lymph nodes, spleen, visceral organs, musculature, marrow, and bones including vertebrae with extension into the spinal canal. A biopsy of the chest wall mass showed high-grade diffuse large B-cell lymphoma. A magnetic resonance imaging (MRI) of the spine demonstrated diffuse marrow replacement by the tumor of the thoracic and lumbar spine with compression of the cord. The prompt treatment with corticosteroids and immunochemotherapy (ICT) was recommended, but the patient elected to seek a second opinion. After two doses of radiation therapy, the patient's general condition rapidly deteriorated and she was hospitalized for systemic ICT. Despite the treatment, her condition continued to deteriorate, and she died 3 weeks after the presentation.

Conclusion: The presented case demonstrates some hitherto unaddressed challenges in evaluation and treatment of mSCC caused by aggressive non-Hodgkin lymphoma (LSSC). The case scrutinizes the role of MRI in uncommon clinical situations. The case has also exposed some ethical issues associated with the proper management of LSCC.

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来源期刊
CiteScore
3.20
自引率
0.00%
发文量
84
期刊介绍: With the first issue in 2014, the journal ''Onkologie'' has changed its title to ''Oncology Research and Treatment''. By this change, publisher and editor set the scene for the further development of this interdisciplinary journal. The English title makes it clear that the articles are published in English – a logical step for the journal, which is listed in all relevant international databases. For excellent manuscripts, a ''Fast Track'' was introduced: The review is carried out within 2 weeks; after acceptance the papers are published online within 14 days and immediately released as ''Editor’s Choice'' to provide the authors with maximum visibility of their results. Interesting case reports are published in the section ''Novel Insights from Clinical Practice'' which clearly highlights the scientific advances which the report presents.
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