Meningite por linfoma primitivo do sistema nervoso central: relato de um caso

Abstract

A invasão das meninges por células neoplásicas oriundas de tumores locaTivemos a oportunidade de acompanhar um caso de meningite neoplásica no qual não logramos determinar a localização da neoplasia inicial em vida. No exame post-mortem encontramos pequeno tumor no plexo coroide do 4? ventriculo e disseminação de células neoplásicas envolvendo o parênquima nervoso e meninges. O tumor foi inicialmente caracterizado como carcinoma de plexo coróide, porém após extensa revisão do material, foi identificado como linfoma primitivo do sistema nervoso central.OBSERVAÇÃO MIP (Registro 570117) com 17 anos de idade, sexo feminino, cor branca. A doença iniciou dois meses antes do internamente, com "sensação estranha na cabeça" e déficit visual transitório matutino. Alguns dias após surgiram vômitos, sem relaç&o com a postura, alimentação ou hora do dia. Trinta dias antes da admiss&o a paciente passou a sentir dores nos membros inferiores, com déficit sensitivo e motor, mais nítido à direita; desde o inicio notou hipacusia que foi progressiva e emagrecimento (perdeu 12 Kg neste período). Na cidade de origem foi submetida a arteriografia carotidiana e pneumoencefalografia que foram normais. O exame do liquido cefalorraqueano colhido Trabalho realizado na

Primary fourth ventricular B-cell lymphoma in an immunocompetent patient

“…Our case, along with the other reported cases [ 5 , 6 , 7 ], showed that PCNSL can arise in rare instances from the fourth ventricle as a solitary mass lesion ( Table 1 ). All four patients were immunologically competent, with ages ranging from 17 to 69 years.…”

“…The incidence of PCNSL has been rising over the last few decades, particularly in immunologically compromised patients with acquired immunodeficiency syndrome [ 1 , 2 , 3 , 4 ]. It is a rare diagnosis in the immunocompetent patient [ 5 , 6 , 7 ]. Most PCNSLs are diffuse, large B-cell lymphomas with a different biological behavior, management and prognosis than systemic diffuse large B-cell lymphomas [ 8 ].…”

“…Three cases of solitary PCNSL arising in the fourth ventricle have been previously reported [ 5 , 6 , 7 ]. The first case was a 17-year-old woman with a clinical presentation of meningitis, and the tumor was diagnosed post-mortem [ 7 ]. The second case was a 33-year-old woman with headaches and vertigo [ 5 ].…”

Primary Isolated Lymphoma of the Fourth Ventricle in an Immunocompetent Patient

“…Our case is unusual in that the lesion is isolated to the fourth ventricle, an extremely rare location that has only been documented in three other cases in literature [3–5] with an additional case having an associated lateral ventricle focus [10]. A solitary enhancing mass in an immunocompetent patient that forms a cast of the fourth ventricle should raise the suspicion of an ependymoma or, less likely, a subependymoma or medulloblastoma.…”

“…PCNSL is usually associated with immunodeficiency (most commonly HIV) but is increasingly observed in immunocompetent patients [2]. We present what is, to the authors' best knowledge, the fourth case of PCNSL isolated to the fourth ventricle and the eleventh case of solely intraventricular PCNSL [3–5]. We attempt to raise awareness of this rare entity and describe our experience with this rare entity.…”