Lymphoma of Nervous System or the Great Imitator in Neurology

Abstract

Background: Lymphoma of the central nervous system (CNS), both primary and secondary, represents a very rare part of patients with non-Hodgkin lymphoma. Methods: Exams included a neurological exam, laboratory blood tests, МRI, biopsy, and electromyography. Results: Three different clinical cases of patients with lymphoma of the nervous system are presented. The first patient is a 44-year-old male admitted to the emergency room because of neck stiffness, with MRI data for a tumour in the left cavernous sinus area. Biopsy was performed 3 months prior to hospitalisation, showing connective tissue, partially hyalinised. Lumbar tap was performed to exclude CNS infection. Cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis, atypical cells in different phases of mitosis, and the result did not confirm lymphocytic choriomeningitis. Flow cytometric measurement (FCM) of CSF led to the diagnosis of T-lymphoblastic lymphoma of CNS. The second patient is a 50-year-old female hospitalised in the authors’ neurological department because of lower limb weakness and decreased sensation, dysphagia, and facial nerve palsy. Brain MRI showed no abnormal lesions. Guillain–Barré syndrome was considered after performing electromyography and electroneurography. CSF showed lymphocytic pleocytosis and 47% of them were atypical. FCM of CSF helped the authors diagnose the patient with B-lymphoblastic lymphoma. The third case presents a 63-year-old male with right sided hemiparesis and progressive cognitive impairment. Previously performed CTs and MRIs of the brain showed both hemispheres and left cerebellar peduncle diffuse lesions. Ischaemic stroke, tumour, and CNS infectious disease were considered. Most of these were excluded because CSF showed no pathological findings. Brain tissue biopsy of one of the lesions was performed, and the patient was diagnosed with diffuse large B cell lymphoma. Conclusion: Lymphoma of the CNS is rare disease. Differential diagnoses include different conditions. FCM of CSF and biopsy could be useful in complicated patients and unknown diagnosis affecting the CNS.