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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(05): 428-429
DOI: 10.1590/0004-282X20160031
IMAGES IN NEUROLOGY

Primary central nervous system lymphoma (PCNSL)

Linfoma primário do sistema nervoso central
Elizabete Maria Pereira de Andrade Caires
1   A. C. Camargo Cancer Center, Departamento de Oncologia Clínica, São Paulo SP, Brasil;
,
Fernando Freua
2   A. C. Camargo Cancer Center, Departamento de Neurologia Clínica, São Paulo SP, Brasil;
,
Felipe D’Almeida Costa
3   A. C. Camargo Cancer Center, Departamento de Patologia Clínica, São Paulo SP, Brasil.
,
Fernanda Lemos Moura
1   A. C. Camargo Cancer Center, Departamento de Oncologia Clínica, São Paulo SP, Brasil;
,
Marcos Aurélio Peterlevitz
2   A. C. Camargo Cancer Center, Departamento de Neurologia Clínica, São Paulo SP, Brasil;
,
Antçnio Alberto Zambon
2   A. C. Camargo Cancer Center, Departamento de Neurologia Clínica, São Paulo SP, Brasil;
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Primary Central Nervous System Lymphoma (PCNLS), an uncommon variant of extranodal non-Hodgkin lymphoma, involves brain, leptomeninges, eyes or spinal cord[1].

A 63-year-old man with two months of cognitive impairment was submitted to brain MRI that revealed a expansive lesion in corpus callosum ([Figure 1A] and 1B). Biopsy was performed and histopathology showed a diffuse large-B-cell lymphoma ([Figure 2]). Cytarabine, metrotrexate and rituximab[2] was performed and after two months, patient returns to the emergency with cerebelar ataxia and somnolence. New brain MRI detected disease progression. Brain radiotherapy was indicated with additional boost of radiotherapy to the tumor bed. After 1 month, patient evolved with seizure and a lumbar puncture revealed meningeal dissemination. It was decided palliative care.

Zoom Image
Figure 1 FLAIR sequence (A) showing expansive mass located in the topography of the fornix and splenium of corpus callosum and extending to the lateral ventricles. Presents intense and homogeneous staining in T1 sequence coronal (B).
Zoom Image
Figure 2 Histologically, the central nervous system parenchyma was diffusely infiltrated by discohesive cells (A, H&E, 100x). At higher power, the neoplastic cells were round and hyperchromatic, with scant cytoplasm and one or two prominent nucleoli (B, H&E, 200x). Immunohistochemically, these cells were strongly positive for CD20 (C, anti-CD20 antibody, 100x) with a high proliferative index (D, Ki-67 antibody, 200x). These findings, together with the clinical and radiological data, supported the diagnosis of primary CNS diffuse large B-cell lymphoma.

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Conflict of interest:

There is no conflict of interest to declare.

  • References

  • 1 Rubenstein J, Ferreri AJ, Pittaluga S. Primary lymphoma of the central nervous system: epidemiology, pathology and current approaches to diagnosis, prognosis and treatment. Leuk Lymphoma. 2008;49(1):43-51. doi:10.1080/10428190802311441
  • 2 Ferreri AJ. How I treat primary CNS lymphoma.Blood. 2011;118(3):510-22. doi:10.1182/blood-2011-03-321349

Address for correspondence

Fernando Freua
Rua Conselheiro Brotero, 1505 / cj 41; 01232-011 São Paulo SP
Brasil   

Publication History

Received: 26 August 2015

Accepted: 04 January 2016

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Rubenstein J, Ferreri AJ, Pittaluga S. Primary lymphoma of the central nervous system: epidemiology, pathology and current approaches to diagnosis, prognosis and treatment. Leuk Lymphoma. 2008;49(1):43-51. doi:10.1080/10428190802311441
  • 2 Ferreri AJ. How I treat primary CNS lymphoma.Blood. 2011;118(3):510-22. doi:10.1182/blood-2011-03-321349

   Permissions and Reprints
Zoom Image
Figure 1 FLAIR sequence (A) showing expansive mass located in the topography of the fornix and splenium of corpus callosum and extending to the lateral ventricles. Presents intense and homogeneous staining in T1 sequence coronal (B).
Zoom Image
Figure 2 Histologically, the central nervous system parenchyma was diffusely infiltrated by discohesive cells (A, H&E, 100x). At higher power, the neoplastic cells were round and hyperchromatic, with scant cytoplasm and one or two prominent nucleoli (B, H&E, 200x). Immunohistochemically, these cells were strongly positive for CD20 (C, anti-CD20 antibody, 100x) with a high proliferative index (D, Ki-67 antibody, 200x). These findings, together with the clinical and radiological data, supported the diagnosis of primary CNS diffuse large B-cell lymphoma.