Tsukamoto Eisuke, Tanei Takafumi, Kato Takenori, Hasegawa Toshinori
Neurosurgery, Komaki City Hospital, Komaki, JPN.
Cureus. 2022 Feb 7;14(2):e21971. doi: 10.7759/cureus.21971. eCollection 2022 Feb.
A 60-year-old man presented with progressive disturbance of consciousness. His father had died of malignant lymphoma, while his mother and sister died of acute leukemia. Magnetic resonance imaging (MRI) revealed multiple high-intensity lesions in the bilateral cerebral hemispheres on diffusion-weighted images. Serum soluble interleukin 2 receptor was 5,640 U/mL. Screenings of blood antibodies known to rise in autoimmune diseases were all normal. Cerebrospinal fluid examinations demonstrated slight elevation of protein and glucose, while the oligoclonal band and myelin basic protein were not elevated. Biopsies of bone marrow and random skin did not show any malignant features. His consciousness gradually deteriorated over a week, with lesions in his right frontal, left temporal, and bilateral parietal lobes shown to be growing. Therefore, open brain biopsy was performed, and one block of the right frontal lesion was harvested. Histological examination revealed atypical large cells only in the capillaries. Although immunohistochemical examinations showed positive staining for CD20, they were negative for CD3. Histopathological diagnosis was intravascular large B-cell lymphoma. After undergoing six cycles of intravenous chemotherapy with rituximab, cyclophosphamide, doxorubicin, and prednisone, his consciousness and neurological symptoms improved, and he appeared to achieve remission. Two years later, there have been no apparent recurrences, and the brain lesions have disappeared.
一名60岁男性出现进行性意识障碍。他的父亲死于恶性淋巴瘤，而他的母亲和姐姐死于急性白血病。磁共振成像（MRI）在弥散加权图像上显示双侧大脑半球有多个高强度病灶。血清可溶性白细胞介素2受体为5640 U/mL。已知在自身免疫性疾病中会升高的血液抗体筛查均正常。脑脊液检查显示蛋白质和葡萄糖略有升高，而寡克隆带和髓鞘碱性蛋白未升高。骨髓活检和随机皮肤活检未显示任何恶性特征。他的意识在一周内逐渐恶化，右额叶、左颞叶和双侧顶叶的病灶显示在增大。因此，进行了开颅脑活检，获取了一块右额叶病灶。组织学检查仅在毛细血管中发现非典型大细胞。尽管免疫组化检查显示CD20呈阳性染色，但CD3呈阴性。组织病理学诊断为血管内大B细胞淋巴瘤。在用利妥昔单抗、环磷酰胺、阿霉素和泼尼松进行六个周期的静脉化疗后，他的意识和神经症状有所改善，似乎达到了缓解。两年后，没有明显复发，脑部病灶已消失。
