Diffusely Infiltrating Central Nervous System Lymphoma Involving the Brainstem in an Immune-Competent Patient
| Autor: | Brad R. Beinlich, M. Shahriar Salamat, Khalid Alsherbini |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Pathology
medicine.medical_specialty Lymphocytic pleocytosis Central Nervous System Neoplasms Lesion Magnetic resonance imaging of the brain Biopsy medicine Brain Stem Neoplasms Humans Cognitive decline medicine.diagnostic_test Lumbar puncture business.industry Lymphoma Non-Hodgkin Magnetic resonance imaging Middle Aged medicine.disease Magnetic Resonance Imaging Female Rituximab Neurology (clinical) medicine.symptom business Immunocompetence medicine.drug |
| Zdroj: | JAMA Neurology. 71:110 |
| ISSN: | 2168-6149 |
| DOI: | 10.1001/jamaneurol.2013.1578 |
| Popis: | A 49-year-old right-handed woman presented with a 3-week history of progressive ataxia, dysarthria, right hemiparesis, cognitive decline, and headache. Infectious, inflammatory, neoplastic, and paraneoplastic workup results were unremarkable. The ophthalmologic evaluation findings were unremarkable for inflammatory or neoplastic involvement. Repeated lumbar puncture findings revealed mild lymphocytic pleocytosis with mildly elevated proteins. Cerebrospinal fluid cytology and flow cytometry results were negative. Magnetic resonance imaging of the brain showed a diffusely enhancing lesion typical for CLIPPERS (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids). 1 Biopsy was felt to be risky given the deep location of the lesion, hence the patient was treated with steroids. The patient showed moderate clinical improvement initially and there was significant reduction in edema on magnetic resonance imaging but persistent perivascular curvilinear enhancement (Figure 1 and Figure 2). With subsequent clinical progression while the patient was taking steroids, a cerebellar biopsy was performed and revealed primary large B-cell non-Hodgkin lymphoma (Figure 3). The patient underwent 4 cycles of high-dose methotrexate, rituximab, and temozolomide. Following the first 2 cycles, she had a complete resolution of her speech symptoms and significant improvement of her rightsided weakness. Unfortunately, her treatment was complicated by steroid-induced diabetes mellitus, bilateral avascular necrosis of the hips and right shoulder, and septic right hip arthritis, which resulted in deconditioning and generalized weakness. Magnetic reso |
| Databáze: | OpenAIRE |
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