HIV and lymphoma successful treatment. Deadly danger. Why is brain lymphoma incurable and how to recognize it. Diffuse histiocytic lymphoma

One of the extranoidal (progressive in non-lymphatic organs) varieties of the group of non-Hodgkin's lymphomas with a high degree of malignancy is cerebral lymphoma... It affects both the tissues of the brain itself and the soft membranes, accumulating mainly near or around the blood vessels.

The diameter of the tumor, as a rule, does not go beyond 2 cm, the neoplasm can be represented by one or several foci, affect the brainstem, corpus callosum, basal ganglia, be localized in the frontal, temporal, parietal or occipital lobes. Most often, GM lymphomas are B-cell tumors, sometimes there are T-cell neoplasms that are characterized by a low degree of malignancy.

In men, this disease is diagnosed about twice as often as in women.

Causes of Brain Lymphomas

All tumors of this type are classified into primary and secondary. Currently, with a high degree of certainty, a relationship has been determined between compromised immunity, in which B cells, actively growing, also actively mutate, and the oncological process in non-lymphatic organs and tissues. Based on this, the prerequisites for development primary lymphomain the brain there can be:

• the presence of HIV;
• artificially reduced immunity, for example, when taking immunosuppressants as part of postoperative therapy after organ transplantation;
• availability epstein-Barr virus (human herpevirus of the fourth type), which causes the proliferation of B cells;
• living in an area with an unfavorable ecological situation, prolonged exposure to radioactive radiation, regular contact with carcinogens;
• wiskott-Aldridge syndrome;
• hereditary genetic mutations;
• elderly age.

Primary GM lymphoma is, according to various sources, from 1 to 3% of the total share of primary oncological diseases central nervous system.

Secondary lymphoma is a consequence of metastasis to the brain of another malignant tumor.

Brain Lymphoma Symptoms

In the initial stages of the disease, symptoms are either absent in principle, or are mild and are often interpreted by patients as a sign of overwork and stress. It is also often associated with disorders of the gastrointestinal tract and arterial hypertension.

So, to the typical symptoms that make it possible to suspect a patient brain lymphoma relate:

• headaches of a bursting nature, most often - with localization in the occipital part;
• dizziness - both long-term and short-term, arising regardless of place and time and alternating with prolonged vestibular stability;
• nausea and vomiting;
• convulsions of the epileptic type;
• chronic fatigue, drowsiness while observing sleep norms, weakness in the upper limbs;
• causeless irritability, mood swings, emotional instability;
• hallucinations, visual and speech disorders, mental disorders and personality disorders;
• breathing disorders, heart rhythm disorders, disturbances of consciousness, fever and others symptomssignaling the manifestation of dislocation syndrome due to displacement of brain structures under tumor pressure.

The patient may have both 2-3 signs of all of the above, and a whole range of symptoms. Their severity depends on the location. tumors in the brain, as well as from the stage of development of the oncological process. In any case, they should be told about them to the treating neurologist or oncologist - this will make it possible to establish the final diagnosis faster and more accurately.

Diagnosis of Brain Lymphoma

To begin with, the patient is assigned a standard examination, which includes general clinical and immunological blood tests, as well as a visit to a neurologist, who assesses the adequacy of consciousness, reflexes, sensitivity, coordination and other neurological aspects.

In cases where lymphoma affecting the brain touches the optic nerve, the patient develops certain visual impairments - blurred vision, limited vision, flashes before the eyes of flies and spots, and some others. In this case, he may be shown an examination by an ophthalmologist.

If the symptoms are limited by nausea and vomiting, it is also advisable to visit a gastroenterologist to exclude problems in the gastrointestinal tract.

The difficulty in diagnosing cerebral lymphoma is that a complete blood count may not show abnormalities, and an immunological study, even if it shows a decrease in response immune system organism, cannot be considered as a direct direct sign of the presence of GM lymphoma in a patient, but is only an indirect confirmation of it. Although the complex of symptoms and laboratory tests still allow one to suspect an oncological process in the brain at an early stage, therefore, tests for general indicators, tumor markers and total immunoglobulins in the blood serum are shown to the patient without fail.

Nevertheless, the main diagnostic study for the described disease is CT or MRI with contrast. In the process of carrying out a computer or magnetic resonance imaging with the use of a contrast reagent, the images show both the neoplasm itself and the swelling of the tissues around it.

The final confirmation of the diagnosis will help a biopsy of the tissues of the formation found on the hardware study. The procedure is invasive, the degree of its trauma depends on the type of intervention. Currently, priority is given to stereotaxic and puncture biopsy due to the minimal risk of these methods for the patient.

Brain Lymphoma Treatment

Brain lymphoma can be controlled by several methods:

• open surgery to remove the formation. This method is used extremely rarely, in exceptional cases, since it entails significant risks of neurological damage;
• exposure to a tumor with a directed beam of radiation using a cyberknife is a method that is also related to the operational, but at the same time less risky than the previous one
• prescribing high doses of corticosteroid drugs. Such treatment can be classified rather as symptomatic: corticosteroids reduce edema and reduce the severity of symptoms. In some cases, there is even a decrease in the size of the tumor, but the disease, nevertheless, continues to progress over time;
• radiation therapy is the standard of care for cerebral lymphoma. It is always used for the aggressive growth of a neoplasm, as well as in the later stages of the oncological process;
• chemotherapy is indicated in combination with radiotherapy or as an independent method of treatment. It demonstrates positive results in the fight against GM lymphoma, however, as practice shows, the use of cytostatics is fraught with acute disorders of cerebral circulation in children and the development of dementia in elderly patients. Therefore, although chemotherapy is included in the current protocol for the treatment of lymphoid tumors in the brain, it is not used in all cases.

The treatment regimen using one or several methods is selected by the oncologist on an individual basis, based on age, health status, the degree of neglect of the oncological process and the presence of concomitant diseases in the patient.

The treatment of lymphoma in patients with HIV deserves special attention. In this case, aggressive antiretroviral therapy is used. According to the results, the life expectancy of such patients increases to 2-3 years, in isolated cases complete remission can be observed, however, in most cases, relapses occur even before the projected 2-3 years have expired.

For patients who are not HIV carriers, forecast with lymphoma, GM is similar. Since this disease is quite rare and there are no materials for systemic scientific research in the required amount, today cerebral lymphoma is considered an incurable disease with a prognosis for life no more than 3 years from the moment of diagnosis.

Shoshina Vera Nikolaevna

Therapist, education: Northern Medical University. Work experience 10 years.

Articles written

Brain lymphoma is rare, which is good news, because it is a fatal pathology. This neoplasm occurs more often in older people and those whose immunity is weak. The insidiousness of the disease lies in the fact that at the initial stages they can only be found by chance, because there is no specific clinic. Such patients do not live long, which is why knowledge about this pathology is so important. What do you need to know about pathology?

What is lymphoma

The concept of lymphoma includes all oncological pathologies that arise from lymphoid tissues, which leads to both swelling of the lymph nodes and neoplasms. When lymphocytes are damaged, pathology has access to all organs in the body from the spleen to the bone marrow, where packets of lymph nodes and tumors will form.

Interesting! Brain tumor lymphoma is more common in men 45-65 years of age with a sluggish and asymptomatic course of 5-10 years. Patients do not even know about its presence, because their health is satisfactory.

A malignant tumor of lymphoma in the brain always has a high degree of damage. This type of cancer can grow from the brain tissue, including the soft tissue, the eyeball. But most often, the primary stages of pathology do not leave the central nervous system and rarely give metastases.

Why arises

The main risk group for lymphoma is the elderly and immunocompromised. But it is possible that it may appear in young people with the same state of the immune system. The following reasons can lead to this:

• vital organ transplant;
• mononucleosis;
• epstein-Barr virus;
• strong radiation exposure;
• prolonged contact with carcinogens;
• heredity to chromosome mutations.

In HIV pathology, the appearance of lymphoma is considered a complication, since the immune system malfunctions. Most often, lymphosarcoma in patients with HIV is fatal, because during therapy the doctor cannot use potent drugs.

Important! Every year more and more people suffer from malignant neoplasms and doctors are inclined to believe that the reason for this is poor ecology and food with carcinogens.

Types of lymphomas

There are only 3 types of such neoplasms that give a clear picture of the pathology.

1. Reticulosarcoma arising in the cells of the reticulum. Until now, research is underway on the nature of its appearance, since this type of cancer is rare and sometimes it is easily confused with lymphosarcoma. The clinical picture can be very diverse and depend on the location and stage of the pathology. The first manifestation affects the lymph nodes. With timely therapy, it gives up to 10 years of remission, responds well to radiation therapy.
2. Microglioma is the most dangerous type of pathology, since its location does not allow therapy with all available methods. This malignant neoplastic neoplasm is quickly and practically incurable, but with a benign microglioma, growth is slow and because of this, symptoms do not appear for a long time. It affects 50% of all patients with brain tumors. Affects glial tissues without invading the bones of the skull and inner shell. It looks like a dense clot without clear forms of pink or red-gray color. The size varies from a millimeter to 15 cm. It can affect both the elderly and the child.
3. Diffuse histiocytic lymphoma is an aggressive pathology with B cells, which rapidly occupies healthy tissues and, during germination, gives new impulses to the central nervous system. The patient loses weight quickly, sweats a lot and suffers from a fever. In a short time, this neoplasm can occupy a vast territory, but even so, it can be treated and good results obtained.

The main symptoms

The clinical picture of lymphoma in the brain is similar to the oncology of the central nervous system.

1. Strong.
2. Fatigue and sleepiness.
3. Neurological manifestations.
4. Epilepsy.
5. Unstable psycho-emotional state.
6. Neuropathic manifestations.
7. Disorder of speech, visual function and memory.
8. Coordination failure.
9. Hallucinations.
10. Tremors and numbness of the limbs.

The last stages of pathology are accompanied by a change in personality, a person's reactions become inadequate with deep memory gaps. This happens especially often when lymphoma is located in the temples and forehead.

In childhood and adolescence, lymphoma is manifested by the following symptoms:

• intracranial hypertension;
• epileptic seizures;
• signs of the meningeal plan;
• cognitive impairment;
• malfunction of the intracranial nerves;
• ocular neuralgia associated with the location and size of the swelling that provoked lymphoma - ataxia, aphasia, hemiparesis, decreased visual function.

Diagnostics in the clinic

Best of all, cerebral lymphoma is shown by a study that allows not only not to visualize, but also to thoroughly study. It will show the current state of the organ, its membranes and cavities. To check the vessels, a CT scan with a contrast agent is prescribed. Clarification of the pathology is carried out using:

• lumbar puncture;
• testing the cerebrospinal fluid for cancer markers;
• and research of its results;
• trepanobiopsy, in which craniotomy is done;
• blood test.

If the lymphoma is secondary, an x-ray, CT scan may be needed. A bone marrow biopsy is performed if the trunk is suspected of being affected by the primary focus. This development of pathology is due to the fact that the brain parenchyma is infiltrated by leukocytes. Secondary lymphoma is extremely painful, which leads to bursting migraines, vomiting, nausea, edema of the optic nerves, partial or complete loss of vision and hearing.

Sometimes it can cause hemorrhage and ischemic heart attack. Any hematoma of the subdural type in the brain leads to a progressive plan. And the risk of this pathology is difficult to compare in terms of the destructive factor for the functioning of the brain and the body as a whole.

Treatment methods

For a long time, radiotherapy has no equal in the fight against lymphomas, it consistently gives high efficiency, but, unfortunately, with a temporary nature, which is associated with radiation exposure. A more stable and sustainable result with a tandem of radioactive and chemical exposure.

With all the effectiveness of chemotherapy, its implementation is the destruction of not only diseased cells, but also healthy ones. Side effects depend on the chosen agent and its dosage. Usually this:

• anemia and severe weakness due to it;
• vomiting and nausea;
• partial or complete hair loss;
• feeling of dry mouth, accompanied by ulcers and wounds;
• failure of the functioning of the gastrointestinal tract;
• a decrease in the capabilities of immunity, which creates a great risk for infection of the body;
• weight loss due to lack of appetite.

If the patient has an adequate immune status, then they tolerate such aggressive therapy easily, receiving remission for several years. This is how oncologists call immunocompetent patients. Some clinics are conducting experimental treatments based on immune and targeted therapies. Unfortunately, long-acting drugs for lymphoma have not yet been developed.

Therapy begins with the administration of corticosteroids to correct the swelling of the brain and normalize the patient's well-being. For chemotherapy, methotrexate is used in high doses, which is administered through a vein or with a lumbar puncture.

Rarely, only one medicine is used in treatment, usually several drugs at once. Most often, combination therapy is based on Etoposide, Tamozolomide, Cytarabin and Rituximab.

Symptomatic treatment removes the accompanying negative clinical picture, such as:

• hypertension;
• severe pain;
• neuropathy;
• hypercalcemia.

Palliative therapy for the last stages of this type of brain cancer is based on blocking pain, often with narcotic analgesics. There is nothing more doctors can do for the patient.

Important! Surgery is not used to treat brain lymphoma, since it is a great risk to disrupt the patient's nervous and mental activity. Doctors have repeatedly tried to neurosurgically remove such tumors, but this invariably led to trauma to the brain structures at a deep level, since the lymph has no clear boundaries.

Oncologists recommend young patients to undergo stem cell transplantation, but this expensive procedure does not always give the expected result. It is difficult to find a donor that perfectly matches all markers. Most often these are direct relatives, but if they are not there, the patient is put on a waiting list. The search for a donor can take years that the patient does not have.

Brain lymphoma: prognosis

Forecasting for patients with this pathology is often not optimistic. Statistics say that only 75% of patients receive five-year remission, provided that the therapy was timely and complete.

In older people, this figure does not exceed 39%. It would seem that a partially curable disease should not return, but relapses are not uncommon for it. And this increases the risk of death for the patient by 2 times. But you can't give up, because there is treatment and it can give an excellent result.

In medical practice, there are cases when patients with brain lymphoma lived for 10-12 years. Usually these are people who have undergone radical therapy, and the side effects from it are no different from the classical method. High efficiency is achieved by suppressing the tumor in a short period of time, which prevents it from growing and ruining human life.

Prevention

All preventive measures to prevent the appearance of cerebral lymphoma should be aimed at eliminating the causes and factors that provoke pathology. And the first on this list is the normalization of the diet.

All food containing carcinogenic substances must be removed from the diet. At the same time, give preference to protein foods such as meat, fish products and eggs. Smokers have a higher risk of suffering from brain lymphoma because tobacco smoke has a relaxing effect on the immune system.

Personal hygiene and control over sexual activity are also important, in which there should be no casual, unprotected relationships, since this is the first path to HIV. Undergoing regular medical examinations will help identify the problem at the initial stage, which will significantly improve the effectiveness of therapy and the duration of remission.

As mentioned above, it is difficult to diagnose lymphoma in the early stages, which is why so often the pathology ends in the death of the patient. Any hint of cancer problems should be immediately checked at the clinic.

The important role of white blood cells is well known. It is the main building block of our immune system. Lymphocytes are responsible for cellular immunity and produce antibodies. But sometimes a malfunction occurs in the body.

Lymph nodes that are present in organs (stomach, brain, lungs, spleen) enlarge and affect them. In them, "tumor" lymphocytes are formed and begin to grow chaotically. There is a cancerous formation of lymphoid tissue - lymphoma.

What is Brain Lymphoma

The central nervous system is less likely than other organs to be affected by lymphoma, but it is the most aggressive form of this disease. The disease invades his lymphatic tissue.

The tumor forms in the tissues (perenchem) and soft membranes of the brain and spinal cord. This malignant neoplasm does not go beyond the boundaries of the central nervous system, although it affects all its parts, even the back wall (membrane) of the eye. Forms metastases rarely.

Brain lymphoma grows slowly. At the initial stages, it is almost asymptomatic, it is diagnosed more often in the later stages, the time for starting treatment is missed.

It is difficult to treat it: it is located in hard-to-reach places. Intracerebral nodes affect the frontal lobe, corpus callosum, or deep brain structures. This pathology is found in elderly people, after 55 years.

Classification

The following lymphomas are known to medicine: B-cell, T-cell, diffuse large B-cell, follicular. But they are not deeply researched. The following classification of malignant tumors of the lymphatic system is generally accepted:

• lymphogranulomatosis (Hodgkin's disease);
• non-Hodginsky lymphomas.

The type of neoplasm, its characteristics are determined after excision of pieces of its tissue. They are examined under an optical microscope. If Berezovsky-Sternberg-Read cells are found, then Hodgkin's disease is present. All other malignant formations are classified as non-Hodgkin.

Primary lymphomas of the brain can have one or many intracerebral nodes. All subspecies are distinguished by the structure of tumor tissues, a set of manifestations of the disease, and methods of therapy.

A number of lymphomas (indolent) develop slowly and safely, urgent intervention is not required. The aggressive ones grow rapidly, have many symptoms and need immediate treatment.

Often lymphocytes begin to grow chaotically in the lymph nodes, increasing them. This is a classic variant of the disease. But if malignant nodes affect the digestive organs, lungs, brain, then these formations are called extranodal, with them the size of the lymph nodes does not change.

The reasons

It is difficult to name specific culprits of cancer, each type has its own etiology. Lymphoma is more common when the immune system is weak. Its root causes are:

• infectious agents;
• various viruses (hepatitis C, herpes type 8). Burkitt's lymphoma often develops in people infected with the herpes simplex virus type 4;
• virus immunodeficiency;
• influence radiation;
• hereditary predisposition, genetic diseases, when there are chromosome mutations (Klinefelter, Chediak-Higashi syndromes or ataxia-telangiectasia);
• constant contact with carcinogens, especially chemicals and heavy metals;
• mononucleosis (acute infectious disease manifested in fever);
• defeat pharynx, lymph nodes, liver, spleen and changes in blood composition;
• autoimmune diseases (Sjogren's syndrome, trophic ulcers, rheumatoid arthritis, systemic lupus);
• transplantation organs and blood transfusion;
• reception medicines, depressing immunity;
• elderly age;
• bad ecology at the place of residence.

Other factors are concomitant, they can trigger the disease mechanism

and lead to chaotic multiplication of cancer cells in the brain.

Symptoms

All clinical manifestations in lymphoma are divided into 2 groups: general and specific for this subtype of malignant formation.

General symptoms

Most of the symptoms in lymphomas are the same for oncology of any location:

1. Painful inflammation lymph nodes on the neck, under the arms, in the groin, as a result of which they are enlarged. Itching in their area. The nodes do not shrink even when taking antibacterial drugs.
2. Weight loss for no apparent reason.
3. Strong sweating due to the rise in temperature, especially at night.
4. Weakness, fast fatigue even without physical exertion.
5. Unstable chair, vomiting, problems with the digestive system.
6. Deterioration vision (the patient sees as in a fog, doubles in his eyes).

Special manifestations

Brain lymphoma also has specific features. They appear because the pia mater is compressed. These include:

• pain heads, her whirling;
• disorders perception (visual, auditory and olfactory hallucinations);
• behavioral changes in mood, lifestyle and actions, thinking;
• violation coordination movements, loss of sensitivity in some part of the body;
• convulsions and seizures of epilepsy.

It is necessary to listen to the body, because initially, cancer may be asymptomatic.

Diagnostics

Lymphoma behaves in such a way that it is sometimes difficult for experienced specialists to diagnose it. But such malignant formations develop according to a certain scenario, and abnormal processes in the nervous system can be traced in development.

Diagnostics will determine the number of lesions, their exact location, size and type of lymphoma.

Medical examination

After it, a further survey plan is determined.

Blood tests (general and biochemical), expanded by the formula

They should be taken regularly. They will tell you how the body reacts to a neoplasm.

Biopsy of the affected lymph node

It is carried out if oncology is suspected anywhere. This is the main analysis that confirms lymphoma, shows the type of neoplasm, its structure, how aggressive it is. A small hole is made in the skull and samples of the affected tissue are taken.

They are sent for morphological and immunological examination under a microscope to a specialist in pathological anatomy. He finds out if they contain lymphoma cells. If they are found, the type of lymphoma is determined.

Radiation diagnostics

X-rays, CT, MRI find and describe tumors in parts of the body that the doctor cannot see during an external examination. Ionizing and non-ionizing radiation will determine the stage of the lymphoma.

A chest x-ray will tell you what is happening to the lymphatic system of the mediastinum and thymus.

Non-Hodgkin's lymphoma is more accurately diagnosed by MRI. The patient is injected with a contrast agent (iodine, barium). It improves the visualization of the organ, identifies new malignant cells, shows layered images of organ tissues.

Bone marrow examination will confirm or deny the presence of aggressive formations in the bone marrow.

Additional methods

If previous studies were uninformative, they perform cytometry (leukocyte counts are counted under a microscope), changes in the chromosome set of cells, anomalies in the number of chromosomes, and molecular genetic studies are established.

Treatment

After confirming the diagnosis, determining the type of lymphoma, stage of the disease, analyzing the patient's condition, a treatment regimen is developed. Non-Hodgkin's lymphoma of the brain is not easy to treat. The organ has a physiological barrier (hematoencephalic) between the bloodstream and the central nervous system. This barrier protects him from injury, so many techniques do not fundamentally affect malignant tumors.

Indolent lymphomas sometimes do not need therapy, rather the observation of an oncologist. But if the disease develops (lymph nodes increase, weakness intensifies, temperature rises) - it should be treated.

If the neoplasm is not widespread, radiotherapy is carried out, tumor lymph nodes are irradiated. When it spreads throughout the body, chemotherapy is indicated. There are many medicines for its implementation: Chlorbutin, Fludarabine, Cyclophosphamide, Vincristine.

Aggressive lymphomas are difficult to treat. The main task of chemotherapy is to prolong the life of a cancer patient and improve its quality. They need to be treated immediately. One of the main chemotherapy regimens is CHOP. This program is used with Rituximab, an antibody produced by immune cells.

Treatment is with chemicals for acute lymphoblastic leukemia. The task of such therapy is to cure the patient. Radical and effective methods of dealing with aggressive and highly aggressive lymphomas are to conduct a course of chemotherapy, then transplant hematopoietic stem cells.

Chemotherapy

Burkitt's lymphoma and all its types lend themselves to this method of treatment. Having determined its type and sensitivity to drugs, a course of mono- or combined chemotherapy is carried out. A puncture is made in the lower back and the medicine is injected into the lumbar spinal canal.

Methotrexate is often used for monochemotherapy. If combined treatment is necessary, choose Cytarabine, Temozolomide or Etoposide. Chemotherapy has many side effects.

Sometimes the patient's condition worsens, but doctors take risks to shrink the tumor. Strong drugs also damage healthy cells, which causes a negative reaction.

You cannot kill only cancerous tissue without affecting healthy ones. Negative manifestations are caused by the doses and aggressiveness of the drug used.

Radiation therapy

It is rarely used by herself, combined with chemotherapy or surgery. At the last stage of the disease, it only temporarily facilitates the well-being of a seriously ill patient, and reduces neoplasm.

It will no longer be so pressing on healthy tissues. The negative reaction from radiation is different and depends on the place where it was carried out.

When exposed to the brain, negative effects from radiation can occur in 2-3 years as neurological pathologies. With a combination of chemotherapy and radiation therapy, the negative consequences of the first can be aggravated.

Operative intervention

Burkitt's lymphoma is not treated by surgery, it is located too in a difficult place. A follicular tumor affects various brain tissues.

It can be located in the cerebellum, and the cellular elements of the irregular structure are scattered throughout the organ. A successful operation is problematic.

It is shown to remove the maximum possible proportion of problem tissues and stop their growth, to take samples for biopsy. Then, radiation or chemotherapy is given to kill the rest of the harmful cells.

If the cancer is at an early stage, and the neoplasm is small in a place accessible for surgical intervention, then its favorable outcome is possible. But you need to make sure that all malignant cells are destroyed. The patient is prescribed chemotherapy to fix the result.

Complications

In the treatment of this disease, adverse reactions and complications are possible. They are the result of chemotherapy and radiation therapy.

Complications after chemotherapy

Of the frequent negative reactions to "chemistry", the following are distinguished:

• frustration at work Gastrointestinal tract digestive problems: nausea, vomiting, diarrhea, or difficult bowel movements;
• weakness, tiredness, fatigue due to anemia;
• dropping out hair;
• weakening immunity predisposition to infections;
• disease mouth gums and throat (dryness, ulceration and sores), excessive sensitivity to hot, cold, salty foods;
• defeat nervous systems: headache, fainting;
• painful Feel;
• worsening coagulation blood, bleeding;
• nervous and muscle phenomena, tingling, burning, muscle and skin pain;
• problems with skin: erythema (redness of the skin due to expansion of capillaries), rash, irritation, dehydration, dryness, acne, increased sensitivity to solar radiation.

Adverse reaction after radiation therapy

Doctors more often record the following complaints of patients after radiation:

• skin blush water bubbles may appear;
• organs excretory systems (kidneys, bladder, ureter) often react poorly to ionizing radiation, excess fluid does not leave the body, swelling of the face and hands appears;
• symptoms similar to ARVI, flu;
• problems with conception.

These complications are quite serious, but more often they are temporary.

The attending physician should tell about the possible consequences, warn about what symptoms the patient should report, prescribe drugs that reduce adverse reactions. In the later stages of the disease, all treatment is aimed at relieving pain.

Forecast

Brain lymphoma has a poor prognosis. It is impossible to quickly remove such an education, there is a risk of damaging the nervous system.

Therefore, the main treatment method is radiation. But it gives only a temporary effect, and remission is short. Patients with this diagnosis live 1.5–2 years. You can also extend your life by a couple of years if you are given chemotherapy.

The outcome of the course of cancer is determined by the type of tumor, its location, stage of the disease and toxicity of the affected tissue.

The prognosis also depends on the patient's age. Young people tolerate the disease more easily, they have better survival rates than old people. Malignant formation in the mediastinum or brain without treatment affects their work, death occurs within a few months. Timely therapy prolongs the life of 40% of patients for 5 years.

The survival rate is increased by stem cell transplantation.

Prevention

There are no special methods of rehabilitation for cerebral lymphoma, because the etiology of the disease is not completely clear.

Recovery after treatment or complications is carried out within the framework of the corresponding nosologies (doctrine of diseases). Experts recommend leading a healthy and, if possible, active lifestyle, being less exposed to direct sunlight, avoiding radiation, and abandoning thermal physiotherapy.

The patient is observed during treatment and after remission of the disease.

Control examination is carried out 30 days after therapy. It includes an MRI of the brain. Tomography will confirm whether signs of illness have weakened or disappeared. The patient is examined first every 3 months, in the next 2-3 years - twice a year.

The patient is registered with the oncology clinic, therefore, for all subsequent years he will be observed by specialists, 1 p. take blood tests per year, if necessary, do a CT scan of the chest, abdomen, pelvis.

The origin of primary central nervous system lymphomas (PLCNS) has been a subject of debate for a long time. There is still no consensus on the original cellular origin, but it is generally accepted that the spread and progression occurs inside the brain. Most of them are B-type cells. T cell lymphomas are relatively rare.

In addition, there is an increasing number of cases of central nervous system lymphomas associated with immunosuppression, HIV infection, or organ transplantation.

and) Epidemiology of Brain Lymphoma... Primary CNS lymphomas are most common in older age groups. The marked increase in frequency caused controversy about possible causes, none of which, however, has been accurately established. According to the latest data, PLCNS accounts for 6% of all primary intracranial neoplasms.

b) Symptoms... Lymphomas usually manifest with seizures or rapidly progressing focal neurological deficits. Symptoms usually do not differ from any other parenchymal intracerebral lesions, and there is no specific or pathognomonic symptom for lymphoma.

in) Complications of cerebral lymphoma... Most complications of PCLCS are associated with treatment. Lymphomas are by nature often accompanied by perifocal edema. Despite this, lymphoma can often be suspected according to neuroimaging data (see below) or in the presence of a concomitant disease (see above), unfortunately, when using steroids, perifocal edema is often leveled, which is clearly visible on T2-weighted MRI. This can lead to the "disappearance" of the lesion (ghosts of the tumor), to an untimely diagnosis and the inability to start appropriate therapy. Stopping steroid treatment will allow the tumor to reappear, but perhaps with a more aggressive course.

While there is still ongoing debate about the role of whole-brain irradiation in the treatment of PLCNS, it is generally accepted that unacceptable neurocognitive disorders develop in older patients with adjuvant chemotherapy. Complications can be avoided by not irradiating the entire brain in elderly patients.

d) Diagnostics... Currently, if lymphoma is suspected, MRI is a mandatory diagnostic method. Lymphomas are typically located in the periventricular white matter, but extensive cortical involvement may occur. Typically, these tumors give a hyperintense and homogeneous signal, therefore, when cortical, they can be mistaken for a meningioma. They are characterized by the appearance of a fuzzy "foggy" field, and necrotic or cystic changes are extremely rare.

Contrast enhancement is also uniform. Multiple lesions are possible. Cases with only arachnoid lesions have been described. PLCNS is a neuroradiological chameleon, it can almost certainly be diagnosed with a characteristic appearance, but due to a wide range of possible manifestations in rare cases, it can simulate almost any pathological changes. If lymphoma is suspected, steroid administration should be avoided before confirming the diagnosis. A histological diagnosis is usually made after a stereotactic biopsy. Sometimes PLCNS is removed if accidentally or significant mass effect is detected.

e) Brain Lymphoma Treatment... Treatment for CNS lymphoma is nonsurgical, except when decompression is required. Over the past decades, various chemotherapy and radiotherapy regimens and combinations have been evaluated. The most common options are based on risk adjustment and invasive chemotherapy, both intraventricular and systemic and additional radiation therapy, depending on the patient's condition.

Methotrexate occupies a leading position in the existing scheme. There are also extrapolations in the treatment of systemic lymphoma using monoclonal antibodies, which makes it possible to overcome the blood-brain barrier and opens up new possibilities in the treatment of these tumors, since they have very special pharmacokinetics. Surgical removal does not add additional benefits to the current chemotherapy regimen.

e) Differential diagnosis... Lymphomas need to be differentiated from metastatic lesions and sometimes from anaplastic lesions. In addition, inflammatory lesions and especially large lesions of multiple sclerosis should be excluded, since their treatment is very different from therapy for lymphoma. A thorough diagnosis of an anamnesis and additional studies, such as cerebrospinal fluid or MR spectroscopy, will help to make a differential diagnosis.

g) Prognosis of brain lymphoma... The prognosis for lymphomas is still poor. However, there is a tendency to increase life expectancy with more intensive, risk-adapted therapy. There are observations of systemic lymphoma with long-term remission and an acceptable quality of life.

h) European standard for the treatment of primary central nervous system lymphoma (PLCNS):
- In case of suspected PCLCS, steroids should not be prescribed until a histological diagnosis is established.
- Histological diagnosis is made on the basis of stereotaxic biopsy.
- Risk-adapted chemotherapy protocols of various intensities are currently the gold standard of treatment.
- Surgical removal of lymphoma is atypical and largely determined by specific circumstances.

T1-weighted MRI with contrast: typical picture of left-sided paraventricular,
deep damage to white matter with a homogeneous structure, without necrosis and fuzzy edges.
A biopsy revealed primary central nervous system lymphoma (PLCNS).
Another case of primary lymphoma of the central nervous system (PLCNS), confirmed by biopsy.
Diffuse subependymal distribution with transition to the corpus callosum.

Brain lymphoma is a rare disease that affects lymphoid tissue. The disease has a malignant character and is concentrated mainly in the meninges. The danger of pathology is that it manifests itself in the last stages, which exacerbates the treatment. The situation is complicated by the fact that the blood-brain barrier does not allow the use of methods that successfully cope with lymphomas in other parts of the body to treat the disease.

Distinguish between non-Hodgkin's lymphoma and Hodgkin's disease. In the first case, a tumor develops in the case of mutation of one lymphocyte cell. When the entire lymphatic system is affected, Hodgkin's disease begins.

Non-Hodgkin's lymphomas of the brain are either primary or secondary. Mostly men are affected by this disease. The primary tumor rarely appears in the brain. More often it is formed due to metastases, and is secondary.

The following types of tumors in B cells are distinguished:

1. Diffuse large cell lymphoma. It is diagnosed in 30% of cases, mainly among the elderly. It is easily treatable, and most patients survive for more than 5 years after being diagnosed.
2. Small cell lymphocytic lymphoma. The tumor grows slowly, but is highly malignant. This type of lymphoma occurs in 7% of patients. This tumor can degenerate into a tumor with rapid growth.
3. Follicular lymphoma. A fairly common tumor, diagnosed in 22% of cases. It grows slowly and has low malignancy. At risk are people over 60 years old. The disease is easily treated, 60% of patients live longer than 5 years.
4. Lymphoma from cells of the mantle zone. Such a tumor grows slowly, but the prognosis of its treatment is unfavorable, since only 20% of patients survive. This lymphoma occurs in 6% of cases.
5. Burkitt's lymphoma. The disease is diagnosed in people over 30 years old, mainly among men. It is very rare, only in 2% of cases. The success of treatment depends on the stage at which the pathology is detected. Timely chemotherapy increases your chances of recovery.

T-tumors are classified as follows:

1. T-lymphoblastic malignant lymphoma. It affects young people in their 20s. She was diagnosed in 75% of cases. The chances of survival increase if the disease is diagnosed early. If the tumor affects the spinal cord, recovery is unlikely and is observed only in 20% of patients.
2. Anaplastic large cell lymphoma. Pathology occurs in young people. Recovery is possible if treatment is started in the early stages.
3. Extranodal T-cell lymphoma. Pathology affects people of any age can occur at different ages, the outcome depends on the stage of the disease.

Reticulosarcoma

Reticulosarcoma is a malignant proliferation of cells of the reticular lymphoid tissue. She does not show herself for a long time. Only in the later stages, when metastases appear, does the patient increase the liver, spleen, and jaundice can begin.

Primary reticulosarcoma is localized in the lymph nodes. At this stage, the lymph nodes are very dense and do not hurt. Over time, the tumor grows in nearby tissues, as a result of which blood circulation and lymph flow are disturbed. When spreading to the lymph nodes of the mediastinum, the neoplasm compresses the esophagus and trachea. Metastases in the abdominal cavity lead to excessive accumulation of fluid in the lower abdomen, and with damage to the vessels passing in the chest cavity, a compression syndrome occurs. Overgrowth in the intestine leads to obstruction.

Microglioma

Refers to primary malignant lymphomas. The neoplasm consists of atypical microglia cells.

Diffuse histiocytic lymphoma

Malignant form of the disease, characterized by the proliferation of large lymphoma cells with abundant cytoplasm and polymorphic nuclei. such cells are capable of phagocytosis, absorbing mainly erythrocytes. It is rarely diagnosed.

Bone marrow lymphoma

The bone marrow stores the stem cells of red blood cells, platelets, white blood cells. Enhanced division of lymphocytes leads to the displacement of blood cells. Thus, hematopoiesis is disrupted. This pathology is called bone marrow lymphoma. It does not show any signs for a long time, and is detected only at 3-4 stages.

The disease is difficult to treat, internal and external factors influence the effectiveness of therapy.

The reasons

The exact causes of the development of brain lymphoma are unknown. In the course of medical research, it was found that brain lymphoma develops with weakened immunity. Pathologies are favored by:

• HIV infection;
• radiation exposure;
• genetic predisposition;
• systematic influence of carcinogens, which include heavy metals and various chemicals;
• epstein-Barr virus;
• infectious mononucleosis;
• environmental conditions;
• organ transplant;
• blood transfusion;
• age after 60 years.

The described factors under certain conditions provoke the development of the disease, especially with a complex effect.

External factors

There are external factors that can cause brain lymphoma. Among them:

• radiation exposure;
• vinyl chloride gas, which is used in the manufacture of plastic;
• aspartame is a sugar substitute.

The reasons for the development of the disease have not been precisely established. Most doctors believe that the appearance of lymphoma is promoted by the electromagnetic field and high-voltage transmission lines.

Weak immune system

People with impaired immune systems are at risk of developing primary brain lymphoma. The causes of lymphoma in immunodeficiency are:

1. Organ transplant.
2. Hereditary predisposition.
3. Contact with carcinogen.

If a healthy person develops lymphoma, it usually develops in the lymph nodes. In patients with immunodeficiency virus, the disease progresses in the spinal cord or brain.

Genetic predisposition

The reason for the development of cancer is a genetic predisposition. Members of the same family face the development of benign tumors, but if treatment is ignored, they can develop into cancer. Children with HIV are often born with brain lymphoma.

Neurofibromatous diseases cause the development of spinal cord tumors. The disease is inherited by first-order relatives.

Symptoms

People with lymphoma in the brain observe the following symptoms to varying degrees:

• speech impairment;
• dropsy;
• visual impairment;
• nerve damage without inflammation;
• numbness of the hands;
• hallucinations;
• mental disorders;
• impaired coordination of movements;
• fever;
• headache;
• dizziness;
• a sharp decrease in weight.

The symptoms of lymphoma are aggravated by the fact that the pathology can lead to ischemic stroke and hemorrhage. Emerging hematomas disrupt brain activity and provoke the development of encephalopathy.

Diagnostics

A number of laboratory methods are used to accurately diagnose lymphoma. Among them:

1. CT scan.
2. Spinal puncture for the study of cerebrospinal fluid.
3. Chest X-ray to examine the condition of the lymphatic system.
4. Trepanobiopsy - examination of brain tissue for the presence of lymphoma by opening the skull.
5. Magnetic resonance imaging of the brain.
6. Stereotactic biopsy for histological examination.
7. General blood analysis.

If there is a lack of information for researching the material, it is possible to use ultrasound or biopsy of the spinal cord, which can detect the disease at the initial stage of development.

Therapy

Whether it is possible to cure lymphoma of the brain with the help of chemotherapy, there is no consensus among doctors. In most cases, complex treatment of brain lymphoma is practiced. During chemotherapy, the patient has an improvement, if large doses of the drugs are used in the treatment. Medicines are selected individually, taking into account the sensitivity of lymphoma to certain substances. It is advisable to use chemotherapy in conjunction with a course of radiation therapy, which increases the patient's life span. This is especially true for HIV-infected patients.

To eliminate the symptoms of the disease, narcotic drugs are used that can reduce pain. Surgery is not recommended because there is a risk of neurological damage due to accidental damage to the tissues surrounding the lymphoma. The operation is also difficult due to the difficulty of establishing clear boundaries of the tumor.

Deprivation begins with a group of non-steroidal anti-inflammatory drugs (non-narcotic analgesics), such as ketans, nise or aertal. These are weak pain relievers and the effect may not be enough even at the initial stage. Of the drugs that can be sold in a pharmacy without a prescription, it is better to ask for celebrex. To purchase narcotic drugs, you will need a prescription form 107-1 / y-NP. The pink form is obtained from a therapist.

The disease in an advanced form is treated with the help of palliative medicine, the essence of which is to provide emotional support to the patient and improve overall well-being. The headaches at this stage are so strong that it is impossible to relieve them with narcotic analgesics.

Forecast

In the absence of treatment, the patient's life span is several months. With chemotherapy, survival may increase up to two years. After a course of radiation therapy, HIV-infected and AIDS patients can survive for about 10 months.

The malignant lesion is reduced with the use of stem cell transplantation. Primary brain lymphoma is difficult to treat. Young people have a better prognosis for survival compared to older people. It must be remembered that in the treatment of chemotherapy, adverse reactions may occur. These include low levels of leukocytes in the blood, tissue death and impaired consciousness.

Irradiation also leads to negative consequences. Patients have mainly neurological disorders, and sometimes years after the procedure.