Lawal Halimat, Anwanane Nya, Atrash Anas
Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, USA.
Internal Medicine, Oakland University, Michigan, USA.
Cureus. 2021 Jun 27;13(6):e15966. doi: 10.7759/cureus.15966. eCollection 2021 Jun.
Primary central nervous system lymphoma (PCNSL) is an uncommon variant of extranodal non-Hodgkin's lymphoma (NHL) that involves the brain, leptomeninges, eyes, or spinal cord without evidence of systemic disease. This article presents a case of a 63-year-old Caucasian female with high-grade B-cell lymphoma who was found to have a solitary brain lesion and no distant metastasis upon diagnosis. The patient had left-sided weakness and difficulty standing on presentation and was found to have a right frontal lobe mass with surrounding mild vasogenic edema and a small focal area of hemorrhage concerning for high-grade glioma versus lymphoma on MRI. However, pathology results revealed high-grade B-cell lymphoma. The case reinforces the importance of working up any lesion suspicious for lymphoma/glioma. Diagnosis of high-grade B-cell lymphoma can be difficult based on morphological and cytological appearance due to varying gene expression and presentation at diagnosis. It can closely mimic diffuse B-cell lymphoma. Extensive workup including HIV serology, MRI imaging, evaluation for spinal cord involvement, and lumbar puncture (LP), to rule out cerebrospinal fluid (CSF) involvement, prior to initiating treatment needs to be done. The case also addresses high-grade methotrexate (MTX)-based chemotherapy as a treatment that improves mortality in patients with primary central nervous system (CNS) lymphoma.
原发性中枢神经系统淋巴瘤（PCNSL）是结外非霍奇金淋巴瘤（NHL）的一种罕见变体，累及脑、软脑膜、眼或脊髓，且无全身疾病证据。本文介绍了一例63岁的高加索女性，诊断为高级别B细胞淋巴瘤，诊断时发现有孤立性脑病变且无远处转移。患者初诊时出现左侧肢体无力和站立困难，MRI检查发现右侧额叶有一肿块，周围有轻度血管源性水肿和一小片局灶性出血，高度怀疑为高级别胶质瘤或淋巴瘤。然而，病理结果显示为高级别B细胞淋巴瘤。该病例强调了对任何可疑淋巴瘤/胶质瘤病变进行全面检查的重要性。由于诊断时基因表达和表现各异，基于形态学和细胞学表现诊断高级别B细胞淋巴瘤可能具有挑战性。它可酷似弥漫性B细胞淋巴瘤。在开始治疗前，需要进行包括HIV血清学、MRI成像、脊髓受累评估和腰椎穿刺（LP）在内的全面检查，以排除脑脊液（CSF）受累。该病例还涉及以大剂量甲氨蝶呤（MTX）为基础的化疗，这是一种可提高原发性中枢神经系统（CNS）淋巴瘤患者死亡率的治疗方法。
