Clinical and diagnostic observation of primary lymphoma of the central nervous system

Abstract

Background. Lymphoma of the central nervous system (CNS), both primary and secondary, is a rare but very aggressive type of non-Hodgkin’s lymphoma. Primary CNS lymphoma (PCNSL) refers to cases confined to the CNS parenchyma, dura mater, leptomeninges, cranial nerves, and spinal cord or intraocular region. The prognosis of PCNSL has been very dismal with an overall survival of 1.5 months without treatment and a 5-year survival rate of 30%. Due to the introduction of high-dose methotrexatebased chemotherapy regimens, there has been substantial progress in treating patients with lymphomas of the CNS, leading to improved survival. Diagnosis and differential diagnosis of PCNSL can often cause complications because it may have similar clinical and radiological signs with some other tumors, primarily with high-grade gliomas and metastatic lesion of the CNS. Stereotactic biopsy remains the main diagnostic method.
 Purpose – to investigate the complexity of the diagnostic and therapeutic process in PCNSL on the example of a clinical case.
 Materials and methods. Clinical observation of patient K., 59 years old, who underwent examination and inpatient treatment at the Department of Radiation Pathology and Palliative Care of the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine» regarding multifocal lesions of the brain (volumetric formations of the white matter of the left hemisphere of the brain).
 Results and discussion. In this clinical case, the presence of multiple volumetric white matter formations of the left hemisphere of the brain in the frontal and temporal lobes of the brain with pronounced perifocal edema, mass effect and signal amplification from the described formations after the administration of a contrast agent in the patient in magnetic resonance imaging allowed us to assume metastatic lesion of the central nervous system. However, a comprehensive examination made it possible to exclude the presence of primary cancer, as well as an infectious lesion of the brain. The diagnosis of primary non-Hodgkin’s diffuse large B-cell lymphoma with damage to the central nervous system was established only after the neurosurgical removal of one of the neoplasms with the conduction of pathohistological and immunohistochemical studies.
 Conclusion. Multifocal brain injury often causes difficulties in diagnosis. Magnetic resonance imaging using T1, T2 and Flair imaging, although very important for the diagnosis of PCNSL, is not always specific. Timely cerebral biopsy with immunohistochemical examination remains the method of choice for verification of the pathological process, which is necessary for the correct treatment.