Takeuchi Issei, Tanei Takafumi, Kuwabara Kyoko, Kato Takenori, Naito Takehiro, Koketsu Yuta, Hirayama Kento, Hasegawa Toshinori
Department of Neurosurgery, Komaki City Hospital, Komaki, Aichi, Japan.
Department of Pathology and Clinical Laboratories, Komaki City Hospital, Komaki, Aichi, Japan.
NMC Case Rep J. 2022 May 31;9:123-128. doi: 10.2176/jns-nmc.2021-0426. eCollection 2022.
An 85-year-old woman presented with ataxia and deterioration of cognitive functions. She had no history of autoimmune diseases or viral infections. Magnetic resonance imaging showed a solitary mass lesion at the cerebral falx on contrast-enhanced T1-weighted imaging. Gross total resection of the lesion involving the dura mater was performed by bifrontal craniotomy. Histological examination showed diffuse infiltration of small lymphocytes and plasma cells. There was also some proliferation of large lymphocytes with folded nuclei, high-density chromatin, and inconspicuous nucleoli. The large atypical B lymphocytes did not demonstrate diffuse dense sheet findings. Meningothelial components were not detected. Immunohistochemistry was positive for pan B-cell antigens. The analysis of the kappa/lambda ratio indicated kappa immunoglobulin light chain-restricted B-cell proliferation. The final histopathological diagnosis was mucosa-associated lymphoid tissue lymphoma. Systemic screening examinations were then performed. Histological findings of the bone marrow showed normal findings without atypical lymphocytes. A chromosomal study of the bone marrow showed 46, XX. 18F fluoro-2-deoxyglucose positron emission tomography showed high accumulations at the left pterygoid muscle and the right transverse processes of the thoracic vertebrae, and mild accumulation at the right ilium bone, which indicated disseminated lesions. One year later, thickening of the dura mater was detected. Therefore, gamma knife surgery was performed. Two years later, she was alive without neurological deterioration, and magnetic resonance imaging showed no evidence of recurrence.
一名85岁女性出现共济失调和认知功能减退。她无自身免疫性疾病或病毒感染史。磁共振成像显示在增强T1加权成像上大脑镰处有一个孤立的肿块病变。通过双额开颅术对累及硬脑膜的病变进行了全切。组织学检查显示有小淋巴细胞和浆细胞的弥漫性浸润。也有一些核折叠、高密度染色质和不明显核仁的大淋巴细胞增殖。大的非典型B淋巴细胞未显示弥漫性致密片状表现。未检测到脑膜内皮成分。免疫组化显示泛B细胞抗原呈阳性。κ/λ比值分析表明κ免疫球蛋白轻链受限的B细胞增殖。最终组织病理学诊断为黏膜相关淋巴组织淋巴瘤。随后进行了全身筛查检查。骨髓组织学检查结果正常，未见非典型淋巴细胞。骨髓染色体研究显示46, XX。18F氟脱氧葡萄糖正电子发射断层扫描显示左侧翼状肌和胸椎右横突有高摄取，右侧髂骨有轻度摄取，提示有播散性病变。一年后，检测到硬脑膜增厚。因此，进行了伽玛刀手术。两年后，她存活且无神经功能恶化，磁共振成像未显示复发迹象。
