Clinical Presentations of 176 Cases of Primary Central Nervous System Lymphoma: A Case Series

Abstract

Background: Primary central nervous system lymphoma (PCNSL) is a malignant tumor, the incidence of which has been increasing in immune compromised patients during the last two decades. Objectives: This study was conducted to determine the most prevalent clinical presenting symptoms of PCNSL patients. Patients and Methods: In this retrospective descriptive study, all PCNSL patients' data over a 25-year period (1990-2014) were assessed. PCNSL was confirmed pathologically after stereotactic biopsy in the Neurosurgery Department of Shohadaye Tajrish Hospital, Tehran, Iran. Results: A total of 176 cases of PCNSL were enrolled. There were 107 (60.8%) male patients, with a 1.5:1 male: female ratio. The patients most commonly presented in the sixth decade of their lives, with a mean age of 47 ± 1.5 years. The most common presenting symptoms were hemiparesis (56.2%) and headache (51.7%). The periventricular white matter (51.1%) and basal ganglion (48.9%) were the most common sites of involvement, and they frequently affected the supratentorial area (84.7%). Conclusions: Based on the data from this study, hemiparesis and headache were the most prevalent clinical presenting symptoms of PCNSL. Cognitive impairment and personality changes were also common in these patients.

Secondary Central Nervous System Lymphoma as a Complication from a Systemic Non-Hodgkin Lymphoma

“…A typical presentation will depend on localization, seizures, motor, sensory deficits, and depressed level of consciousness if ICP is high. Localization is most common supratentorial in more than 80% of cases, being periventricular white matter and basal ganglia, the most commonly reported followed by ependymal extension, the later of great importance for differential diagnosis in imaging [17][18][19]. Classical MRI appearance shows single or multiple lesions isointense or hypointense in T1WI, homogenously isointense or hypointense to the cortex in T2 and enhancing lesion with contrast.…”

Case Review: Primary T-cell CNS Lymphoma in a Pediatric Immunocompetent Patient

“…Patients can also present with symptoms due to leptomeningeal involvement with neuronal lymphomatosis as the sole manifestation, such as headache, difficulty speaking, altered mental status, seizures and weakness. Additional presenting symptoms include signs of elevated intracranial pressure, 6th nerve palsy, bilateral 3rd nerve palsy, mononeuritis multiplex, unilateral hearing loss, and bilateral 7th nerve paralysis [24]. A cross-sectional retrospective study conducted in Shohadaye Tajrish Hospital in Tehran, Iran, during a 25-year period (1990 -2014) showed that symptoms are often widespread and multifocal.…”

“…It could be a single tumor or a multifocal disease. The most common site is a space occupying parenchymal mass [24]. On imaging, there is no definitive pattern for diagnosis and reactive processes cannot be ruled out.…”

Efficacy and Toxicity of Treatments for Primary Central System Lymphoma: Review of the Recent Literature

“…PCNSL most commonly involves the periventricular white matter (51%) and basal ganglia (48.9%). The most frequent presenting symptoms were shown to be hemiparesis (56.2%) and headache (51.7%) in a retrospective study of 176 patients with PCNSL (7). Other common symptoms include neuropsychiatric symptoms and other signs of raised intracranial pressure (i.e.…”