Abstract
Objectives. Keywords. Primary central nervous system lymphoma; HIV.
Introduction. Primary central nervous system lymphoma (PCNSL) is a rare subtype of non-Hodgkin
extranodal lymphoma, accounting for ~3% of all brain tumours. It can involve the brain, eyes, leptomeninges
and spinal cord without evidence of it outside the central nervous system. Diagnostics can be very difficult,
because there are no specific clinical or radiological signs, and in many cases diagnose can be mixed with
central nervous system toxoplasmosis, acute disseminated encephalomyelitis, neurosarcoidosis etc.
Case description. A 72-year-old man was admitted to the hospital with mild left-sided hemiparesis
and central facial nerve paresis on the left side. The patient underwent a non-contrast CT, which showed
no evidence of ischemia, but a pathological mass in the right parietal lobe was suspected. A further brain
MRI examination showed multiple peripheral contrast-enhancing leasions in both brain hemispheres.
Possible brain metastases or opportunistic neuroinfection were considered in the differential diagnosis.
Cerebrospinal fluid analyses were performed and neuroinfections (both bacterial and viral) were ruled
out. A contrast CT scan of the abdomen, pelvis and chest excluded other possible primary pathological
processes. The patient was tested for HIV, which was positive, with the possibility of AIDS stage. Due to
the gradual clinical deterioration and since he received steroid therapy during hospitalisation, it was decided
not to perform a biopsy.
Summary. In this case PCNSL is the most likely diagnosis for this patient, due to its high association
with HIV and the exclusion of other possible diagnoses that presents with this kind of neuroradiological
signs.
Conclusions. This case highlights the importance of considering PCNSL as a differential diagnosis in
patients with pathological brain masses and HIV infection. Additionally, the use of steroids before biopsy
may adversely affect the pathological accuracy and delay the definitive diagnosis of lymphoma.
Introduction. Primary central nervous system lymphoma (PCNSL) is a rare subtype of non-Hodgkin
extranodal lymphoma, accounting for ~3% of all brain tumours. It can involve the brain, eyes, leptomeninges
and spinal cord without evidence of it outside the central nervous system. Diagnostics can be very difficult,
because there are no specific clinical or radiological signs, and in many cases diagnose can be mixed with
central nervous system toxoplasmosis, acute disseminated encephalomyelitis, neurosarcoidosis etc.
Case description. A 72-year-old man was admitted to the hospital with mild left-sided hemiparesis
and central facial nerve paresis on the left side. The patient underwent a non-contrast CT, which showed
no evidence of ischemia, but a pathological mass in the right parietal lobe was suspected. A further brain
MRI examination showed multiple peripheral contrast-enhancing leasions in both brain hemispheres.
Possible brain metastases or opportunistic neuroinfection were considered in the differential diagnosis.
Cerebrospinal fluid analyses were performed and neuroinfections (both bacterial and viral) were ruled
out. A contrast CT scan of the abdomen, pelvis and chest excluded other possible primary pathological
processes. The patient was tested for HIV, which was positive, with the possibility of AIDS stage. Due to
the gradual clinical deterioration and since he received steroid therapy during hospitalisation, it was decided
not to perform a biopsy.
Summary. In this case PCNSL is the most likely diagnosis for this patient, due to its high association
with HIV and the exclusion of other possible diagnoses that presents with this kind of neuroradiological
signs.
Conclusions. This case highlights the importance of considering PCNSL as a differential diagnosis in
patients with pathological brain masses and HIV infection. Additionally, the use of steroids before biopsy
may adversely affect the pathological accuracy and delay the definitive diagnosis of lymphoma.
| Original language | English |
|---|---|
| Pages (from-to) | 250 |
| Number of pages | 1 |
| Journal | Medicina (Kaunas) |
| Volume | 59 |
| Issue number | Suppl.2 |
| Publication status | Published - 29 Mar 2023 |
| Event | RSU Research Week 2023: Research Week 2023 Rīga Stradiņš University - Riga Stradins University, Riga, Latvia Duration: 27 Mar 2023 → 31 Mar 2023 https://rw2023.rsu.lv/general-information https://rw2023.rsu.lv |
Field of Science*
- 3.2 Clinical medicine
Publication Type*
- 3.4. Other publications in conference proceedings (including local)
