Abstract
Intraparenchymal, low-grade primary central nervous system lymphomas are rare entities. We present a case of HIV negative, non-dural, low-grade primary central nervous system B cell lymphoma. A 35 year-old man presented with memory and visual disturbance. Magnetic resonance imaging demonstrated a high intensity lesion on T2 weighted images in right medial temporal lobe to basal ganglia, with irregular enhancement by gadorinium. The lesion was suspected to be high-grade glioma, however, intraoperative frozen pathology suggested lymphoma. Histopathological examination showed diffuse perivascular infiltration of small atypical lymphocyte which were positive for CD20 and CD79a. The lesion was positive for immunoglobulin heavy chain (IgH) rearrangement. Histopathological diagnosis was primary central nervous system lymphoma, low-grade B cell malignancy. The patient undertwent 5 courses of high dose methotrexate therapy (3.5 g/m2), however, recurrence was noted after therapy in brain stem. The patient was re-treated with 3 courses (4.5 g/m2), followed by whole brain irradiation. The lesion almost disappeared, and the patient is free of symptoms at 30 months from diagnosis. Although low-grade primary central nervous system lymphoma is considered relatively indolent, the present case and literature suggest that intraparenchymal, low-grade primary central nervous system lymphomas are mostly progressive, and early treatment including irradiation may be a choice.
References
Miller DC, Hochberg FH, Harris NL et al (1994) Pathology with clinical correlations of primary central nervous system non-Hodgkin’s lymphoma. The Massachusetts General Hospital experience 1958–1989. Cancer 74(4):1383–1397
Tu PH, Giannini C, Judkins AR et al (2005) Clinicopathologic and genetic profile of intracranial marginal zone lymphoma: a primary low-grade CNS lymphoma that mimics meningioma. J Clin Oncol 23:5718–5727
Jahnke K, Korfel A, O’Neill BP et al (2006) International study on low-grade primary central nervous system lymphoma. Ann Neurol 59(5):755–762
Carrasco CA, Rojas-Z D, Chiorino R et al (2012) Primary pituitary lymphoma in immunocompetent patient: diagnostic problems and prolonged follow-up. Pituitary 15(1):93–96
Park I, Huh J, Kim JH et al (2008) Primary central nervous system marginal zone B-cell lymphoma of the Basal Ganglia mimicking low-grade glioma: a case report and review of the literature. Clin Lymphoma Myeloma 8(5):305–308
Roser F, Saini M, Meliss R et al (2004) Apoptosis, vascularity, and proliferation in primary central nervous system lymphomas (PCNSL): a histopathological study. Surg Neurol 62(5):393–399
Hauser SL (2006) Low-grade central nervous system lymphoma: clarity through a hazy lens. Ann Neurol 59(5):9A–10A
Papanicolau-Sengos A, Wang-Rodriguez J, Wang HY et al (2012) Rare case of a primary non-dural central nervous system low grade B-cell lymphoma and literature review. Int J Clin Exp Pathol 5(1):89–95
Ferreri AJ, Reni M, Pasini F et al (2002) A multicenter study of treatment of primary CNS lymphoma. Neurology 58(10):1513–1520
DeAngelis LM, Seiferheld W, Schold SC et al (2002) Combination chemotherapy and radiotherapy for primary central nervous system lymphoma: radiation therapy oncology group study 93–10. J Clin Oncol 20(24):4643–4648
Hiraga S, Arita N, Ohnishi T et al (1999) Rapid infusion of high-dose methotrexate resulting in enhanced penetration into cerebrospinal fluid and intensified tumor response in primary central nervous system lymphomas. J Neurosurg 91(2):221–230
Thiel E, Korfel A, Martus P et al (2010) High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma (G-PCNSL-SG-1): a phase 3, randomised, non-inferiority trial. Lancet Oncol 11(11):1036–1047. doi:10.1016/S1470-2045(10)70229-1
Poortmans PM, Kluin-Nelemans HC, Haaxma-Reiche H et al (2003) High-dose methotrexate-based chemotherapy followed by consolidating radiotherapy in non-AIDS-related primary central nervous system lymphoma: European organization for research and treatment of cancer lymphoma group phase ii trial 20962. J Clin Oncol 21(24):4483–4488
Van den Bent MJ, Afra D, de Witte O et al (2005) Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet 366(9490):985–990
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Tomio, R., Sasaki, H., Hirose, S. et al. Intraparenchymal, primary central nervous system lymphoma of low-grade B cell malignancy: a case report with review of the literature on therapeutic consideration. Int Canc Conf J 4, 73–80 (2015). https://doi.org/10.1007/s13691-014-0173-7
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DOI: https://doi.org/10.1007/s13691-014-0173-7