Ayalew Zekarias Seifu, Gebregiorgis Mahlet, Azibte Gebeyehu Tessema, Hamza Abdurrhman Kedir, Abdo Isa Salo, Molla Bereket Abraha
Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Division of Hematology, Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Radiol Case Rep. 2024 Aug 7;19(10):4644-4649. doi: 10.1016/j.radcr.2024.07.039. eCollection 2024 Oct.
Primary central nervous system lymphoma is a rare form of central nervous system malignancy. It predominantly affects immunocompromised individuals and the elderly population. Diffuse large B-cell lymphoma is the most common type. This case report presents a 35-year-old female patient presented with progressive difficulty maintaining balance, headaches, seizures, and blurry vision for 2 months. Physical examination was unremarkable except for sluggish bilateral pupillary reaction and lower extremity weakness. MRI revealed multiple bilateral intraaxial masses. Biopsy and immunohistochemistry confirmed diffuse large B-cell lymphoma, nongerminal center B-cell type. However, the diagnosis was delayed for 4 months. The delay in the diagnosis was caused by its atypical presentation, a surgical site infection, and limited resources, which led the patient to disregard the recommended treatment and leave the hospital against medical advice. Even in the absence of risk factors of primary central nervous system lymphoma, it should be considered as a differential in a young patient with neurologic symptoms and intraaxial mass. Minimally invasive biopsy techniques and readily available immunohistochemistry are essential for prompt diagnosis and guiding treatment.
原发性中枢神经系统淋巴瘤是中枢神经系统恶性肿瘤的一种罕见形式。它主要影响免疫功能低下的个体和老年人群。弥漫性大B细胞淋巴瘤是最常见的类型。本病例报告介绍了一名35岁女性患者，出现进行性平衡障碍、头痛、癫痫发作和视力模糊2个月。体格检查除双侧瞳孔反应迟钝和下肢无力外无异常。磁共振成像显示双侧多个脑内肿块。活检和免疫组织化学证实为弥漫性大B细胞淋巴瘤，非生发中心B细胞型。然而，诊断延迟了4个月。诊断延迟是由于其非典型表现、手术部位感染和资源有限，导致患者忽视推荐的治疗并违反医嘱出院。即使没有原发性中枢神经系统淋巴瘤的危险因素，对于有神经系统症状和脑内肿块的年轻患者，也应将其列为鉴别诊断之一。微创活检技术和现成的免疫组织化学对于及时诊断和指导治疗至关重要。
