SLE患者に発生した頭蓋内原発悪性リンパ腫の1例

A Case of Primary Intracerebral Malignant Lymphoma in Systemic Lupus Erythematosus

I．はじめに

　従来より自己免疫疾患と悪性リンパ腫との関係は注目されており，全身性エリテマトーデス（SLE）でも合併率が高いという報告がある^6,26）．SLEに頭蓋内悪性リンパ腫が合併した報告例は渉猟し得た文献上5例あった^{4,12，13,21,25）}．われわれは，SLE発症後に頭蓋内原発悪性リンパ腫を併発し，放射線治療や化学療法で比較的長期間寛解が得られた症例を経験したので報告する．

The patient, a 49-year-old female, was admitted to our department because of right hemiparesis and left oculomotor nerve palsy on February 7, 1986. Neither lymphadenopathy nor hepatosplenomegaly was present. She had been treated with prednisolone for systemic lupus erythematosus (SLE) for one and a half year be-fore admission.

The CT scan revealed a homogeneously enhanced mass lesion from the midbrain through the thalamus on the right side. The whole body gallium scintigram showed no abnormal uptake except in the brain.

Stereotaxic biopsy was performed. Histopathological diagnosis was malignant lymphoma, diffuse, large cell type (International Working Formulation). The enhanced mass lesion disappeared after radiation therapy. Subsequently, she received chemotherapy. She remained well untill May 1988 when she died because of the systemic lymphadenopathy.

The association of malignant lymphoma and SLE has appeared occasionally in the literature. Primary in-tracerebral malignant lymphoma associated with SLE is much rarer but it should be considered in the differen-tial diagnosis of symptoms of the central nervous sys-tem in a patient with SLE. Therefore, biopsy of a cere-bral mass lesion is mandatory if appropriate therapy such as radiation and chemotherapy is to be adminis-tered.