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本文报告ALL长期存活的37例中,3例于远期发生了神经胶质瘤。这37例ALL均接受过包括中枢神经系统放疗预防及鞘内氨甲喋呤(MTX)治疗。例1,男,17岁。6岁时患ALL,结束治疗后85个月(患ALL后11年)出现左面部Jacksonian癫痫发作,渐及左侧肢体。周围血、骨髓象均正常。脑电图示右侧癫痫病灶,CT扫描示右顶部亮度增加,环以水肿带。用皮质类固醇治疗,病情有改善,2个月后,病人出现左侧轻度偏瘫。CT扫描证实为多发性右侧半球病变。于顶部皮层下病变处取活检,证实为含有典型的少突神经胶质细胞瘤的病变。手术治疗后,又接受30.5Gy全颅放疗。临床和放射学检查曾一度有改善,1年后死亡。例2、3略。
In this paper, of the 37 patients with long-term survival of ALL, 3 cases developed glioma in the long-term. These 37 ALL patients had received radiation therapy including central nervous system prevention and intrathecal methotrexate (MTX) treatment. Example 1, male, 17 years old. At the age of six, she developed ALL, and at the end of treatment 85 months (11 years after ALL), a left-faced Jacksonian seizure occurred, gradually progressing to the left limb. The surrounding blood and bone marrow were normal. The electroencephalogram shows right epileptic focus. The CT scan shows an increase in brightness at the right top and an edema band around the ring. Treatment with corticosteroids improved the condition, and after 2 months, the patient developed mild left hemiplegia. A CT scan confirmed multiple right hemispheric lesions. Biopsies were taken at the top subcortical lesions and confirmed to contain lesions typical of oligodendrogliomas. After surgery, he received 30.5Gy full-cranial radiotherapy. Clinical and radiological examinations once improved and died after 1 year. Examples 2, 3 omitted.