Primary central nervous system germinal center B-like diffuse large B-cell lymphoma: a case report

Area of Science:

• Neurology
• Oncology
• Pathology

Background:

• Primary central nervous system (CNS) diffuse large B-cell lymphoma (DLBCL) is a rare non-Hodgkin lymphoma.
• Diagnosis can be challenging due to nonspecific symptoms and imaging findings that may mimic other neurological conditions.
• Germinal center B-like (GCB) subtype of primary CNS DLBCL is particularly uncommon.

Observation:

• A 54-year-old HIV-negative female presented with a 2-month history of intermittent fever and progressive paralysis.
• Magnetic resonance imaging (MRI) revealed an infiltrative enhancing brain lesion.
• The lesion initially resembled multiple sclerosis (MS) and did not respond to immunosuppressive therapy.

Findings:

• Brain biopsy confirmed the diagnosis of primary CNS diffuse large B-cell lymphoma (DLBCL).
• Morphological and flow cytometric analyses indicated the germinal center B-like (GCB) subtype.
• This case highlights the diagnostic difficulties and the importance of considering biopsy in suspected CNS lesions.

Implications:

• The patient's lack of response to immunosuppressive therapy underscores the need for a definitive diagnosis.
• This case emphasizes the importance of considering biopsy for CNS lesions, particularly those near the cortex, to avoid misdiagnosis.
• Further analysis explored the reasons for the patient's insensitivity to immunosuppressive treatment.