A healthy 75-year-old man with type 2 diabetes who had been followed up for relative
lymphocytosis of unknown cause for 8 years presented to our clinic because he suddenly
lost the ability to keep the score while playing tennis. Neurological examination
was unremarkable. Blood tests showed a high soluble interleukin-2 receptor concentration
(1150 U/mL, reference range: 157–474 U/mL). Computed tomography showed a 4-cm, high
intensity, edematous mass mimicking brain hemorrhage in the right temporal lobe (Figure 1A). Subsequent T-2 weighed magnetic resonance imaging with contrast showed a well-demarcated
mass, the rim of which was irregularly enhanced (Figure 1B). A diagnostic craniotomy was performed. Pathological examination of the operative
specimen revealed primary diffuse large B-cell lymphoma (DLBCL) of the central nervous
system with perivascular proliferation by atypical large lymphocytes (perivascular
cuffing, which is a characteristic feature of DLBCL of the central nervous system)
(Figure 1C) with irregularly-shaped nuclei that stained positive for CD20 (Figure 1D), CD79a, bcl-2, and MUM1. Three courses of high-dose methotrexate therapy with cranial
irradiation were not effective.
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References
- Primary CNS lymphoma.J Clin Oncol. 2017; 35: 2410-2418
- Primary central nervous system lymphoma.Arch Pathol Lab Med. 2008; 132: 1830-1834
- Modern concepts in the biology, diagnosis, differential diagnosis and treatment of primary central nervous system lymphoma.Leukemia. 2011; 25: 1797-1807
Article info
Publication history
Published online: May 17, 2022
Accepted:
May 12,
2022
Received:
February 18,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
