Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
World Neurosurg. 2020 Nov;143:490-494. doi: 10.1016/j.wneu.2020.07.213. Epub 2020 Aug 4.
Cases of primary central nervous system lymphoma manifesting with hemorrhage are very rare, with only a few previous studies available.
A 49-year-old man presented with occipital headache and visual disturbance for the past 4 months. Computed tomography showed a high-density area involving the left basal ganglia, with surrounding vasogenic edema. Head T2∗-weighted imaging showed a hypointense signaling area. Edematous changes and a midline shift were observed on fluid attenuated inversion recovery magnetic resonance imaging. Radiologic features were highly suggestive of intracerebral hemorrhage. Methylprednisolone pulse therapy improved his symptoms transiently and reduced the size of the lesion. Nonetheless, there was recurrence 1 month later. The patient was referred to our institution; a biopsy was performed, and a diffuse large B-cell lymphoma was diagnosed. After 3 cycles of high-dose methotrexate and whole-brain radiation therapy, his symptoms improved, and there were no signs of recurrence.
We report a very rare case of diffuse large B-cell lymphoma manifested with intratumoral hemorrhage. This case indicates the importance of regular clinical and radiologic follow-up, histopathologic examination, and combined treatment with high-dose methotrexate and whole-brain radiation therapy.
原发性中枢神经系统淋巴瘤伴出血的病例非常罕见，仅有少数既往研究可供参考。
一名 49 岁男性因过去 4 个月出现枕部头痛和视力障碍而就诊。计算机断层扫描显示左基底节区有高密度区，伴有周围血管源性水肿。头部 T2∗ 加权成像显示低信号区域。液体衰减反转恢复磁共振成像显示水肿性改变和中线移位。影像学特征高度提示为颅内出血。甲泼尼龙脉冲治疗使他的症状短暂缓解，病灶缩小。然而，1 个月后再次复发。患者转至我院，行活检后诊断为弥漫性大 B 细胞淋巴瘤。接受 3 个周期大剂量甲氨蝶呤和全脑放疗后，他的症状改善，无复发迹象。
我们报告了一例非常罕见的弥漫性大 B 细胞淋巴瘤伴瘤内出血的病例。该病例表明定期进行临床和影像学随访、组织病理学检查以及大剂量甲氨蝶呤和全脑放疗联合治疗的重要性。
