Atypical presentation of primary central nervous system non-Hodgkin lymphoma in immunocompetent young adults

World Neurosurg. 2013 Mar-Apr;79(3-4):593.e9-13. doi: 10.1016/j.wneu.2012.07.026. Epub 2012 Aug 7.

Abstract

Objective: Primary central nervous system non-Hodgkin lymphoma (PCNSL) is a malignant lymphoma limited to the cranial-spinal axis in the absence of systemic lymphoma. Historically, PCNSL accounts for fewer than 5% of all cases of primary intracranial neoplasms. PCNSL is rare in immunocompetent young adults. Although the prognosis for PCNSL is poor, approximately 20%-30% percent of cases achieve a cure.

Methods: We report two cases of PCNSL originating in the ventricle in otherwise healthy immunocompetent young adults.

Results: A 27-year-old man presented with 10 days of nausea, vomiting, and headache and was found to have a large intraventricular mass emanating from the choroid plexus with resultant hydrocephalus. He underwent placement of external ventricular drain and systemic and intrathecal chemotherapy for cytologically proven PCNSL. A 31-year-old pregnant woman presented with headaches, vision difficulties, and ataxia and was found to have a septum pellucidum mass. She underwent craniotomy and subtotal resection of the mass with subsequent systemic therapy and whole brain radiation for treatment of PCNSL.

Conclusions: To our knowledge, this is the first report of primary CNS lymphoma of the choroid plexus and septum pellucidum in otherwise healthy, immunocompetent young adults.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Central Nervous System Neoplasms / diagnosis*
  • Central Nervous System Neoplasms / surgery
  • Central Nervous System Neoplasms / therapy*
  • Cerebral Ventricle Neoplasms / diagnosis
  • Cerebral Ventricle Neoplasms / surgery
  • Choroid Plexus Neoplasms / diagnosis
  • Choroid Plexus Neoplasms / surgery
  • Choroid Plexus Neoplasms / therapy
  • Combined Modality Therapy
  • Craniotomy
  • Drainage
  • Female
  • Flow Cytometry
  • Humans
  • Hydrocephalus / etiology
  • Immunocompetence
  • Lymphoma, Non-Hodgkin / diagnosis*
  • Lymphoma, Non-Hodgkin / surgery
  • Lymphoma, Non-Hodgkin / therapy*
  • Magnetic Resonance Imaging
  • Male
  • Neurosurgical Procedures
  • Postoperative Care
  • Pregnancy
  • Pregnancy Complications, Neoplastic / diagnosis
  • Pregnancy Complications, Neoplastic / surgery
  • Pregnancy Complications, Neoplastic / therapy
  • Septum Pellucidum / pathology
  • Septum Pellucidum / surgery
  • Tomography, X-Ray Computed
  • Treatment Outcome