PRIMARY INTRACEREBRAL MALIGNANT-LYMPHOMA - A CLINICOPATHOLOGICAL STUDY OF 89 PATIENTS

The authors report on a clinicopathological study of 89 surgical patie nts with histologically proven primary parenchymal brain lymphoma, all diagnosed between January 1975 and December 1990. The cohort included 60 men and 29 women whose median age at diagnosis was 60 years (range 14 to 84 years). The duration of symptoms was less than 8 weeks in 48 % of the patients. Symptom groups included focal neurological deficit (73%), neuropsychiatric symptoms (28%), seizures (9%), and increased i ntracranial pressure (3%). A total of 132 tumors were seen in 89 patie nts: the most common sites were frontal (32 patients), temporoparietal (31 patients), and basal ganglia (17 patients); multiple lesions were reported in 23 patients. No patient had antecedent of human immunodef iciency virus positivity or acquired immunodeficiency syndrome. A fami ly history of cancer was present in 33% of the patients, three-quarter s of whom were first-degree relatives. Histological subtypes (National Cancer Institute Working Formulation) included 64 large cell (72%) an d 13 immunoblastic (15%) tumors. Phenotype was determined in 66 patien ts: 63 were B-cell type and three were T-cell type. Surgical resection was performed in 47% of the cases, with the remainder undergoing biop sy only. All but six patients received radiation therapy. Thirty-one p atients received chemotherapy, whereas 46 patients did not; data on th e remaining 12 patients were unavailable. The end point of the study w as death from any cause. At the time of last contact, 69 of the patien ts (78%) had died; the median survival time for this study group was 2 0.9 months. On univariate analysis, prognostic factors significantly a ssociated with survival included age at diagnosis, family history of c ancer, and focal neurological deficit. Multivariate analysis revealed four unfavorable prognostic factors: age greater than or equal to 60 y ears, history of cancer in first-degree relatives, focal deficit, and ependymal contact. After adjustment for these variables, clinical synd rome, size and number of lesions, extent of surgery, histological cell type, radiation dose, and use of chemotherapy were not significantly associated with survival.