Primary intraventricular central nervous system lymphoma in an immunocompetent patient

Area of Science:

• Pediatric Neurology
• Neuro-oncology
• Diagnostic Imaging

Background:

• Obstructive hydrocephalus in adolescents can present with non-specific symptoms like headache, vomiting, and seizures.
• Empirical antituberculosis treatment is sometimes used for suspected central nervous system infections, potentially delaying definitive diagnosis.
• Intraventricular central nervous system lymphoma is a rare condition, particularly in pediatric patients.

Observation:

• A 15-year-old male experienced a 6-month history of headache, vomiting, and seizures.
• Magnetic resonance imaging (MRI) revealed solid, nodular, enhancing masses within the bilateral lateral and fourth ventricles.
• The patient underwent septostomy and ventriculoperitoneal shunting for obstructive hydrocephalus.

Findings:

• Surgical biopsy of the fourth ventricular lesion confirmed a B-cell lymphoma.
• Staging evaluations, including MRI, positron emission tomography, and bone marrow biopsy, were unremarkable.
• Diagnosis of primary intraventricular central nervous system lymphoma was established.

Implications:

• This case underscores the necessity of considering rare neoplastic conditions in the differential diagnosis of pediatric obstructive hydrocephalus.
• Accurate and timely diagnosis of primary central nervous system lymphoma is crucial for appropriate oncological management.
• Advanced imaging techniques and tissue biopsy remain essential for definitive diagnosis and staging of central nervous system tumors.