Critical revision of the role of surgery for treatment of primary brain b cell lymphoma in an immunocompetent patient: a case report and literature review

Abstract

Primary Central Nervous System Lymphoma (PCNSL) are malignant tumors extremely rare in immunocompetent patients. They represent 2-3% of all cerebral tumors.They are frequently located in the supra-tentorial space and in 60-70% of cases they consist in single lesions. The most common presenting symptoms are hemi paresis, ache, epileptic crises and ataxia. In this article we present the case of a 76 year-old woman admitted for seizures attack and progressive coma state. A preoperative CT scan with contrast enhancement showed a left frontal nodular lesion of 29x16mm, with irregulars enhancement and surrounded by peripheral edema. No alteration of haematological exams was noticed. The patient underwent surgery for with total excision of the lesion. Histological examination was suggestive of non-Hodgkin B cells lymphoma (CD20+, CD 30-). Patient improved after surgery and she was discharged ten days after surgery, with the indication to perform hematologic consult. No recurrences were noticed at 20months follow-up. Although surgery is not routinely recommended for the treatment of PCNSL, we report a case of B-cells lymphoma in which surgical resection, followed by chemotherapy and radiation therapy, resulted in a successful treatment. A critical review of the role of the surgery in consideration of technical advances in neurosurgery was done.