基底核に腫瘤を形成した転移性中枢神経系悪性リンパ腫―定位手術的照射（stereotactic radiosurgery）が著効した1例―

A Rare Massive Parenchymal Metastasis in Central Nervous System from Abdominal Non-Hodgkin Lymphoma:Effectiveness of Stereotactic Radiosurgey :： Case Report

要旨　Non-Hodgkin lymphomaの中枢神経系への転移は少ない。また転移形式の大半は髄膜播種や硬膜外腫瘤であり，脳実質内に腫瘤を作ることは稀である。われわれは，左片麻痺で発症し，基底核内に35mmの腫瘤が認められ，stereotactic biopsyを行いその組織型を確認した転移性中枢神経系悪性リンパ腫の1例を経験した。診断においては¹²³I-IMP SPECTが有用であり，治療においてはstereotactic radiosurgeryが有効で，腫瘍は消失し，左片麻痺も改善した。

A 62-year-old female presented with a rare massive parenchymatous metastasis from abdominal malignant lymphoma. Computed tomography and magnetic resonance image revealed a large enhanced mass in the right basal ganglia. ¹²³I-IMP SPECT showed increased uptake on both early and delayed images. A stereotactic biopsy was performed;histological examination revealed a diffuse large B-cell malignant lymphoma. The patient underwent stereotactic radiosurgery（SRS）. Short-term cliniconeuroradiological follow-up showed both neurologic improvement and virtually complete disappearance of the tumor. Our findings suggest that ¹²³I-IMP SPECT can help differentiate malignant lymphoma from benign lesions and other malignant brain tumors. In addition, SRS with conventional radiotherapy may be an effective therapeutic strategy to control malignant lymphoma.