医学
磁共振成像
放射治疗
淋巴瘤
弥漫性大B细胞淋巴瘤
原发性中枢神经系统淋巴瘤
放射科
活检
病变
甲氨蝶呤
脑活检
中枢神经系统
立体定向活检
病理
外科
内科学
作者
Costansia Bureta,Nayuta Higa,Ryutaro Makino,Tomoko Takajo,Hajime Yonezawa,Hiroyuki Uchida,Koji Yoshimoto
标识
DOI:10.1016/j.wneu.2020.07.213
摘要
Cases of primary central nervous system lymphoma manifesting with hemorrhage are very rare, with only a few previous studies available. A 49-year-old man presented with occipital headache and visual disturbance for the past 4 months. Computed tomography showed a high-density area involving the left basal ganglia, with surrounding vasogenic edema. Head T2∗-weighted imaging showed a hypointense signaling area. Edematous changes and a midline shift were observed on fluid attenuated inversion recovery magnetic resonance imaging. Radiologic features were highly suggestive of intracerebral hemorrhage. Methylprednisolone pulse therapy improved his symptoms transiently and reduced the size of the lesion. Nonetheless, there was recurrence 1 month later. The patient was referred to our institution; a biopsy was performed, and a diffuse large B-cell lymphoma was diagnosed. After 3 cycles of high-dose methotrexate and whole-brain radiation therapy, his symptoms improved, and there were no signs of recurrence. We report a very rare case of diffuse large B-cell lymphoma manifested with intratumoral hemorrhage. This case indicates the importance of regular clinical and radiologic follow-up, histopathologic examination, and combined treatment with high-dose methotrexate and whole-brain radiation therapy.
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