Multiple primary central nervous system lymphoma in the ventricular system and interpeduncular cistern: A case report

Multiple primary central nervous system lymphoma (PCNSL) in the ventricular system is rare. The present study describes a case of multiple PCNSL in the left lateral ventricle, 4th ventricle, medulla and interpeduncular cistern and reviews the relevant literature. A 67-year-old male with no previous medical history presented with nausea and vomiting for 6 months and orthostatic hypotension for 2 weeks. Magnetic resonance imaging showed multiple homogeneously enhancing lesions in the left lateral ventricle, 4th ventricle, medulla and interpeduncular cistern. A midline posterior fossa craniotomy was performed with maximal safe resection of the lesion in the 4th ventricle, and histopathology of this lesion was consistent with diffuse large B-cell lymphoma. The symptoms of the patient were relieved after surgery. Postoperative chemotherapy was administered within 3 weeks and the patient was followed up for 1 year. The case of multiple PCNSL in the ventricular system, medulla and interpeduncular cistern likely originated from the choroid plexus and spread through the cerebrospinal fluid. Currently, resection and chemotherapy is considered the best treatment option for PCNSL. PCNSL in the 4th ventricle is suitable for the combination of maximal safe resection and chemotherapy, which can reduce the possibility of obstructive hydrocephalus.