Primary Central Nervous System Lymphoma 
with Peripheral Nerve Involvement: 
Case Report.

Area of Science:

• Neuro-oncology
• Hematology
• Medical imaging

Background:

• Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma.
• Cerebellopontine angle (CP) masses can present with diverse neurological symptoms.
• High-dose methotrexate (MTX) and craniospinal irradiation are standard treatments for CNS lymphomas.

Observation:

• A 50-year-old man with a CP angle mass diagnosed as DLBCL.
• Initial chemotherapy with high-dose MTX led to tumor regression but was followed by neurological deficits.
• FDG-PET revealed widespread peripheral nerve involvement, indicating leptomeningeal and perineural spread.

Findings:

• Chemotherapy and craniospinal irradiation initially controlled the disease.
• Recurrence in peripheral nerves necessitated salvage chemotherapy with R-CHOP.
• FDG-PET was crucial in diagnosing and monitoring the extent of DLBCL spread.

Implications:

• DLBCL can exhibit extensive leptomeningeal and perineural spread, even after initial treatment.
• Multimodal therapy including chemotherapy, radiation, and FDG-PET imaging is essential for managing CNS lymphoma.
• Early detection and aggressive treatment are critical for improving outcomes in patients with widespread DLBCL involvement.