Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Neurology, Yuncheng Central Hospital of Shanxi Province, Shanxi, China.
Medicine (Baltimore). 2022 Dec 30;101(52):e32567. doi: 10.1097/MD.0000000000032567.
Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin lymphoma, and isolated meningeal PCNSL, without evidence of parenchymal involvement, is even less common, occurring in only 10% to 15% of cases.
A 65-years-old female presented to our hospital with progressive lower extremity motor dysfunction and blurred vision. The initial neurological examination revealed decreased muscle strength in both lower extremities and sensory dysfunction of lower extremities, saddle area, and buttocks. Brain magnetic resonance imaging showed no abnormalities. Lumbar enhanced magnetic resonance imaging showed T11 to L3 horizontal meningeal enhancement. Cerebrospinal fluid (CSF) cytology revealed lymphoma cells. Immunohistochemistry and flow cytometry of the CSF were performed as auxiliary methods to establish the diagnosis of lymphoma.
The patient was diagnosed primary meningeal central nervous system lymphoma.
During hospitalization, the patient was treated with 2 courses of high-dose intrathecal methotrexate and rituximab combined with intrathecal chemotherapy and supportive treatment.
After 2 years of follow-up, the patient was able to walk and take care of herself.
Cases of PCNSL involving only the meninges are rare. Multimodal analysis of the CSF comprises an important component of the diagnostic work-up for patients with primary meningeal central nervous system lymphoma.
原发性中枢神经系统淋巴瘤（PCNSL）是一种罕见的结外非霍奇金淋巴瘤，而无实质受累的孤立性脑膜 PCNSL 更为少见，仅占病例的 10%至 15%。
一位 65 岁女性因进行性下肢运动功能障碍和视力模糊就诊于我院。初始的神经系统检查显示双下肢肌力下降，下肢、鞍区和臀部感觉功能障碍。脑部磁共振成像未见异常。腰椎增强磁共振成像显示 T11 至 L3 水平脑膜增强。脑脊液（CSF）细胞学检查显示淋巴瘤细胞。CSF 的免疫组化和流式细胞术作为辅助方法用于建立淋巴瘤的诊断。
患者被诊断为原发性脑膜中枢神经系统淋巴瘤。
住院期间，患者接受了 2 个疗程的高剂量鞘内甲氨蝶呤和利妥昔单抗联合鞘内化疗和支持治疗。
随访 2 年后，患者能够行走并自理。
仅累及脑膜的 PCNSL 病例罕见。CSF 的多模态分析是原发性脑膜中枢神经系统淋巴瘤患者诊断评估的重要组成部分。
