ABSTRACT
Primary brain lymphoma is a rare variant of extranodal non-Hodgkin's B-cell lymphoma. In >90% of cases, this is diffuse large B-cell lymphoma with CD20 expression and is confined to the brain, meninges, spinal cord, and eyes. It accounts for fewer than 7% of primary brain tumors. Its incidence has been rising in recent years in immunocompetent patients in their fifth and sixth decades. The rate of relapse after initial therapy based on high-dose methotrexate and/or total brain irradiation is high. There is no consensus for treating relapse, which ranges from retreatment with high doses of methotrexate, polychemotherapy, high doses of chemotherapy backed up by autologous stem-cell transplant to intrathecal chemotherapy, with widely differing results. Given the lack of consensus and poor results, new therapy options have appeared, including immunotherapy with rituximab. At a systemic level, alongside chemotherapy, its results are very modest and limited due to the low concentration it reaches in cerebrospinal fluid (CSF). However, its intrathecal and intraventricular use, though only isolated cases have been reported, has provided promising results (AU)
Subject(s)
Humans , Male , Middle Aged , Antibodies, Monoclonal, Murine-Derived/administration & dosage , Antineoplastic Agents/administration & dosage , Brain Neoplasms/drug therapy , Brain Neoplasms/pathology , Eye Neoplasms/drug therapy , Lymphoma, Large B-Cell, Diffuse/drug therapy , Eye Neoplasms/pathology , Eye Neoplasms/secondary , Injections, Spinal/methods , Injections, SpinalABSTRACT
El carcinoma de origen desconocido se define como la existencia de enfermedad metastásica sinprimario detectable al diagnóstico. Supone hasta el 3% de las neoplasias malignas y es uno de los 10diagnósticos de cáncer más frecuente. La definición requiere la realización de una serie de exploracionesbásicas para determinar que no existe tumor primario conocido. Dentro de este heterogéneo grupoexisten una serie de entidades clinicopatológicas que presentan un mejor pronóstico, ya que tienen untratamiento específico. El esfuerzo en la búsqueda del primario irá encaminado a definir estas entidadesy a saber reconocerlas. Actualmente existen diversas técnicas de inmunohistoquímica, biologíamolecular y radiodiagnóstico que parecen facilitar la labor al clínico a la hora de detectar el origen delos tumores, aunque ninguna de ellas es concluyente. Intentaremos analizar las distintos métodos diagnósticos,así como definir aquellas entidades que se beneficiarán de un tratamiento concreto
Carcinoma of unknown primary origin is defined as the appearance of a metastatic disease where noprimary tumor is detectable. It represents up to 3% of the malignant neoplasms and is among the tenmost frequent cancer diagnosis. The consideration of cancer of unknown primary localization requiresthe performance of several basic explorations resulting insufficient to diagnose a primary tumor.Within the heterogeneous group of cancer of unknown origin, there are some clinicopathologic entitieshaving specific treatment whose diagnosis would represent a better prognosis. It is then necessary tostrive for making the diagnosis of the primary tumor, having in mind such entities. There arenowadays several techniques that may help this purpose, related with immunochemistry, molecularbiology and radiodiagnosis, although even with them the results may be inconclusive. We attempt inthis work to analyze the different diagnostic methods, and to define those entities which may benefitwith a particular treatment
