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Primary Central Nervous System Lymphoma in an Immunocompetent Patient Presenting as Multiple Cerebellar Lesions: A Case Report and Review of Literature

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Primary Central Nervous System Lymphoma in an Immunocompetent Patient Presenting as Multiple Cerebellar Lesions: A Case Report and Review of Literature

Gliceida M Galarza Fortuna et al. J Investig Med High Impact Case Rep.

Abstract

Primary central nervous system (CNS) lymphoma (PCNSL) is an uncommon extranodal non-Hodgkin lymphoma often presenting as a single brain lesion within the CNS. On histopathological evaluation of PCNSL a positive CD10, which is frequently observed in systemic diffuse large B-cell lymphoma, is present in approximately 10% of PCNSL. We describe a case of CD10-positive PCNSL presenting with multiple posterior fossa enhancing lesions in an immunocompetent older woman with a history of breast cancer successfully treated by the RTOG 0227 protocol consisting of pre-irradiation chemotherapy with high-dose methotrexate, rituximab, and temozolomide for 6 cycles, followed by low-dose whole-brain radiation and post-irradiation temozolomide.

Keywords: CD10; brain tumor; cerebellar tumor; lymphoma; primary CNS lymphoma.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Brain MRI showing multiple enhancing brain lesions including a 0.7-cm right superior anterior cerebellar parenchymal lesion (A, arrow), 0.3-cm and 0.2-cm left paramedian cerebellar vermian lesions (A, dashed arrow), a 1.9-cm superior right cerebellar lesion with mass effect and surrounding vasogenic edema causing partial effacement of the right aspect of the fourth ventricle (B), and a 0.2-cm left thalamic lesion (C, arrow).
Figure 2.
Figure 2.
Brain biopsy showing a cellular infiltrate with necrosis and perivascular preservation (A) composed of large lymphoid cells with centralistic morphology and numerous apoptotic bodies (B), immunoreactive for CD-20 (C), Bcl-6 (D), and CD-10 (E) consistent with a DLBCL of germinal center phenotype. The lymphoma exhibited a high proliferation index (>95%).
Figure 3.
Figure 3.
Brain MRI after 6 cycles of chemotherapy completion showing interval resolution of the multiple enhancing lesions in the posterior fossa. No evidence of residual or new foci of primary CNS lymphoma.

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