Primary Cerebral Lymphoma With Spontaneous Remission
Hernández Rubio, L., Giner Bernabeu, J. C., Perez Sempere, Á., & Toro, P. (2013). Primary cerebral lymphoma with spontaneous remission. Neurologia (Barcelona, Spain), 28(2), 123–126. https://doi.org/10.1016/j.nrl.2011.08.002
View Original Source →Case Details
Disease Location
Cerebral, right frontal cc, reaching the contralateral hemisphere
Personal Characteristics
65 -year-old male history of pulmonary thromboembolism 2 years before which need treatment with acenocoumarol for 6 months. Was not taking any medication at admission
Clinical Characteristics
Visited emergency department due to dizziness and verightigo with acute onset a week before the visit - had progressively worsening symptoms which responded poorly to vestibular sedatives neurological exam only showed mild gait instability, cranial CT scan revealed a right frontal hypodense focus affecting the cc and reaching the contralateral hemisphere, there was no enhancement MRI showed a hyperintense right frontal lesion affecting the cc and extending to the left hemisphere with patchy enhancement. There were also a hyperintense lesion in both cerebellar hemispheres and the pons during the first days in the hospital, the patient's neurological state worsened with more acute dysarthria and ataxia another MRI was performed finding the same lesions plus a new right frontal lesion with enhancement and increased uptake of contrast in the splenium of the cc. Primary cerebral lymphoma was suspected thus blood testing, CT scan, csf analysis, and PET were performed. Whole-body PET revealed malignant hypermetabolic lesions limited to the brain corticosteroids were avoided a brain biospy of the right frontal lesion revealed non-specific gliosis and no malignancy the patient was discharged with no treatment and carefully monitored, gradual improvement of the neurological situation improved gradually 4 months later... 9 months after being admitted, the patient returned for a check-up due to symptoms of headache and vomiting which began a few days prior upon neurological exam, the patient was drowsy and presented time disorientation, moderate dysarthria, limited vertical gaze with conjugate gaze palsy, and left faciobrachiocrural hemiparesis a new MRI revealed several lesions with contrast uptake in the cerebellum, mesencephalon, and right internal capsule. Lesions were treated with corticosteroids a few days later, the patient presented dysphagia to liquids and the paresis evolved into left hemiplegia cerebellar lesion was biopsied - no evidence of malignancy the patient died a few days later autopsy revealed a lymphoid neoplasm diffusely infiltrating the brain parenchyma and forming concentric perivascular cuffs, there was also significant astrocytic, histiocytic, and microglial responses observed immunological and histochemical studies confirmed b-cell lymphoid neoplasm due to strongly positive CD20 and 79a markers. Ki-67 proliferation index was high (70%)
Remission Characteristics
4 months later the patient was aympatientomatic and leading a normal life MRI performed showed nearly complete disappearance of the lesions and no contrast uptake in any of them
Treatment & Mechanisms
Proposed Remission Mechanisms
Immune theory higher percentages of natural killer cells no major proposed mechanism for this case
Clinical Treatment
None reportedfor first lesions after recurrence, corighticosteriods were administered
Non-Clinical Treatment
None reported