Department of Neurosurgery, Asahikawa Medical University, Hokkaido, Japan.
Br J Neurosurg. 2023 Aug;37(4):697-700. doi: 10.1080/02688697.2019.1568391. Epub 2019 Feb 11.
We report a case of a primary malignant lymphoma of the trigeminal nerve that was associated with facial pain. A 65-year-old man was examined at another hospital for unilateral facial pain. Carbamazepine was prescribed, but his symptoms did not improve. Magnetic resonance imaging (MRI) revealed swelling of the trigeminal nerve and a mass lesion in Meckel's cave. The patient was referred to our hospital at this point. Gadolinium-enhanced MRI and F18-Fluorodeoxyglucose-position emission tomography suggested a likely malignant tumour and a biopsy was performed. Histopathological examination showed diffuse a large B cell lymphoma. The patient was treated with high-dose methotrexate (HD-MTX) and radiotherapy. Despite responding well to initial treatment, the patient relapsed, with lymphoma observed throughout the body. He died of pneumonia 18 months after the initial diagnosis. Facial pain is a symptom that is commonly managed in general practice. If symptoms do not improve, repeated imaging studies, including contrast MRI, is warranted. This is the first reported case of primary neurolymphomatosis (NL) of the trigeminal nerve associated with facial pain alone. Furthermore, HD-MTX and radiotherapy may be considered for the management of primary NL of a cranial nerve.
我们报告一例原发性三叉神经恶性淋巴瘤病例，该病例与面部疼痛有关。一名 65 岁男性因单侧面部疼痛在另一家医院接受检查。给予卡马西平治疗，但症状未改善。磁共振成像（MRI）显示三叉神经肿胀和 Meckel 氏腔肿块病变。此时患者被转至我院。钆增强 MRI 和 F18-氟代脱氧葡萄糖正电子发射断层扫描提示可能为恶性肿瘤，并进行了活检。组织病理学检查显示弥漫性大 B 细胞淋巴瘤。患者接受了大剂量甲氨蝶呤（HD-MTX）和放疗。尽管初始治疗反应良好，但患者复发，全身可见淋巴瘤。初始诊断后 18 个月，患者死于肺炎。面部疼痛是一种常见于普通科治疗的症状。如果症状未改善，需要进行重复的影像学检查，包括对比 MRI。这是首例报告的原发性神经淋巴瘤病（NL）单纯累及三叉神经伴面部疼痛的病例。此外，对于颅神经的原发性 NL，可考虑使用 HD-MTX 和放疗进行治疗。
