Bokhari Rakan, Ghanem Ahmad, Alahwal Mahmoud, Baeesa Saleh
Division of Neurological Surgery, Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
Case Rep Oncol Med. 2013;2013:614658. doi: 10.1155/2013/614658. Epub 2013 Mar 28.
Primary central nervous lymphoma (PCNSL) is a rare variant of extranodal non-Hodgkin's lymphoma with a especially poor prognosis. The diagnosis is usually encountered in immunodeficient patients but is also encountered, albeit uncommonly, in the immunocompetent. We present a 50-year-old male who developed signs and symptoms of increased intracranial pressure. Imaging revealed the presence of a fourth ventricle mass with obstructive hydrocephalus. First, the patient underwent emergency endoscopic third ventriculostomy followed, few days later, by complete tumor resection via a posterior fossa craniotomy. Postoperative histopathology revealed the lesion to be a PCNSL. He received adjuvant chemotherapy and radiation and remained with no recurrence on regular imaging studies for 18-month followup. We report herein the fourth case of isolated PCNSL lesion to the fourth ventricle in the literature and provide the rationale for our belief that craniotomy and tumor resection, if feasible, should be the initial line of management in similar cases to relieve hydrocephalus and achieve the diagnosis.
原发性中枢神经系统淋巴瘤（PCNSL）是结外非霍奇金淋巴瘤的一种罕见变体，预后特别差。该诊断通常见于免疫缺陷患者，但在免疫功能正常的患者中也有发现，尽管并不常见。我们报告一名50岁男性，出现颅内压升高的体征和症状。影像学检查显示第四脑室有肿块并伴有梗阻性脑积水。首先，患者接受了急诊内镜下第三脑室造瘘术，几天后，通过后颅窝开颅术进行了肿瘤全切。术后组织病理学检查显示病变为PCNSL。他接受了辅助化疗和放疗，在18个月的随访期间，定期影像学检查未发现复发。我们在此报告文献中第四例孤立的PCNSL病变位于第四脑室的病例，并阐述我们的观点，即在类似病例中，如果可行，开颅肿瘤切除术应作为初始治疗方案，以缓解脑积水并明确诊断。
