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Primary central nervous system plasmablastic lymphoma presenting in human immunodeficiency virus-negative but
Li Ying Zhang1, Hui Yun Lin, Lan Xiang Gao
1Department of Pathology, The Military General Hospital of Beijing PLA, Members of Chinese Medical Association, Dongcheng District, Beijing, People's Republic of China.
Abstract:
We report a 32-year-old Outer Mongolian man, with plasmablastic lymphoma (PBL) primarily occured in the central nervous system and diagnosed by surgical resection. This patient appeared headache and magnetic resonance imaging (MRI) showed multiple lesions in the right cerebral hemisphere including the right frontal-parietal lobe and right basal ganglia and the left cerebellum, he was diagnosed as lymphoma by stereotactic biopsy in January 2009 in local hospital, and was given radiotherapy 33 times after the biopsy. The patient was admitted to The Military General Hospital of Beijing PLA., Beijing, P.R. China on March 9th, 2011, with chief complaints of right limbs convulsioned suddenly, then fell down and lose of his consciousness, then awoke after 4 to 5 minutes, with symptoms of angulus oris numbness and the right upper limb powerless ten days ago.MRI of the brain revealed a well-defined hyperdense and enhancing mass in the left frontal-parietal lobe, the meninges are closely related, there was extensive peritumoural edema noted with pressure effects, as evident by effacement of the left lateral ventricles and a 0.5 cm shift of the midline to the right side.Surgical resection showed markedly atypical, large singly dispersed or cohesive proliferation of plasmacytoid cells with frequent abnormal mitoses and binucleation, some neoplastic cells were large with round or oval nuclei and showed coarse chromatin and smaller or unapparent nucleoli, some neoplastic cells with prominent nucleoli, apoptosis and necrosis were often presented. Immunohistochemistry staining and gene rearrangement together with other supportive investigation confirmed the diagnosis of primary central nervous system plasmablastic lymphoma. A month later, he was started on chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, leurocristime and prednisone) for a week. Other supportive treatment was provided for symptomatic epilepsy. The patient regained muscle strength in both upper limbs and right lower limb and the symptomatic epilepsy was controlled after two weeks. Then the patient was discharged. Follow-up data shows the patient to be alive eleven months after discharge.
Virtual Slides:
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1649317674697046.
Insights
This case study details a 32-year-old man with primary central nervous system plasmablastic lymphoma (PCNS PBL). The patient presented with neurological symptoms and was successfully treated with surgical resection and chemotherapy, showing positive outcomes.
Area of Science:
- Neuropathology
- Oncology
- Neurosurgery
Background:
- Plasmablastic lymphoma (PBL) is an aggressive non-Hodgkin lymphoma.
- Primary central nervous system (PCNS) PBL is rare, often presenting with diverse neurological symptoms.
- Accurate diagnosis and timely treatment are crucial for managing PCNS PBL.
Observation:
- A 32-year-old man presented with headache, seizures, and neurological deficits.
- MRI revealed multiple enhancing lesions in the brain, suggestive of a CNS malignancy.
- Surgical resection provided tissue for histopathological and immunohistochemical analysis.
Findings:
- Histopathology showed atypical plasmacytoid cells with abnormal mitoses, confirming PBL.
- Immunohistochemistry and gene rearrangement studies supported the diagnosis of PCNS PBL.
- The patient received R-CHOP chemotherapy and supportive care for epilepsy.
Implications:
- This case highlights the importance of considering PCNS PBL in patients with unexplained neurological symptoms.
- Surgical resection followed by chemotherapy can lead to favorable outcomes in PCNS PBL.
- Further research is needed to optimize treatment strategies for PCNS PBL.
